The staging of Chronic Obstructive Pulmonary Disease (COPD) includes four stages, with the last stage often referred to as “end stage”. Though stage IV or “end stage” may be a clinical term for the last of the four stages in the standard COPD staging guidelines, it certainly doesn’t mean the end stage of one’s life.

The Four Stages of COPD

The diagnosis and staging of COPD begins with spirometry which uses a machine called a spirometer to measure lung function, specifically how efficiently the lungs empty. The results of the test place patients in one of the four stages of COPD.

Though some factors, such as age, sex, and height, play a role in the staging, it’s important to understand that there are several other factors that will determine how well you are able to live and manage your COPD regardless of your stage.

The following is a breakdown of the stages of COPD to help give you a basic understanding of each stage:

Stage 1 - Mild COPD with only mild airflow limitation. In this stage a patient might not even be aware that there is an abnormality in lung function.

Stage 2 – Moderate COPD with progressing airflow limitation. This is most commonly the stage at which people seek medical help for chronic symptoms, often shortness of breath during exertion or even exacerbation of COPD.

Stage 3 – Severe COPD with airflow limitation that is progressing even further and impacting the patient’s quality of life because of greater shortness of breath and reduced exercise capacity.

Stage 4 – Very Severe COPD with severe airflow limitation and exacerbations that are life-threating. A severely impaired quality of life is also common with this stage.

As you can see, the staging is quite generalized. It is an assessment tool that is used to help determine the severity of the disease and how it may impact one’s health. It also helps doctors predict a patient’s risk of exacerbations so that the best course of treatment can be determined for better symptom control and even slowing progression of disease for a longer, and better quality of life. On its own, it is not an accurate predictor of life expectancy.

Stage IV COPD Isn’t a Death Sentence

When diagnosed with Stage IV or “end stage” COPD, it’s easy to let your mind go to a dark place and fear the worst. While COPD at any stage isn’t something that anyone wants, learning that you are in the final stage can be frightening. A better understanding of this stage and what you can do about it is important. Talking about life expectancy and the possibility of death is difficult, but learning what you can do to prolong your life can take away a lot of the fear associated with this stage.

A study published in the Journal of Respiratory Medicine in 2008 looked at the different factors that play a role in mortality associated with COPD and found that in the majority of cases, individuals with COPD “die with their disease and not from it,” referring to not only the finding that other issues are often the reason for death, but also pointing out various studies that show how COPD patients can successfully improve symptoms of the disease as well as survival through various treatments and lifestyle changes. An example of this is in the discovery that treatment with long-acting inhaled bronchodilators, either on their own or combined with inhaled corticosteroids, can result in sustained improvements in lung function for up to a year.

Living with Stage IV COPD

A Stage IV COPD diagnosis is not the end. Taking charge of your health by working with your doctor to manage your symptoms and prevent exacerbations can help you slow the progress of your disease so that you can better live with “end stage” COPD.

The National Heart, Lung, and Blood Institute suggest the following steps to help you do this:

  • Quit smoking
  • Avoid lung irritants
  • Be prepared for emergencies
  • Manage the disease and its symptoms

Quitting smoking when you already have later stage COPD may not make much sense, but the as stated by The Lung Association, “It helps to quit smoking even if you already have COPD”. They also point out in their guide to treating COPD that even though you can’t reverse the damage that’s been done to your lungs; you can protect them from more damage. And according to the Centers for Disease Control and Prevention (CDC), nine out of 10 COPD-related deaths can be attributed to smoking.

Along with avoiding smoke and other lung irritants like pollution and chemicals, pulmonary rehabilitation programs can help educate you on lifestyle changes that will help you live your best with Stage IV COPD. And, learning to be prepared to emergencies can limit the amount of damage done and the severity of the episode. Living with Stage IV COPD is possible with the right treatment plan and lifestyle changes.