End-Stage COPD



  1. Chronic obstructive pulmonary disease (COPD) is a progressive condition that affects your ability to breathe well.
  2. End-stage COPD is very serious and can significantly affect your quality of life.
  3. Quitting smoking is one of the best things you can do at any stage of COPD.

Chronic obstructive pulmonary disease (COPD) is a progressive condition that affects your ability to breathe well. It encompasses several medical conditions, including emphysema and chronic bronchitis. According to The Cleveland Clinic, there are 23.6 million people in the United States that suffer from COPD. Cigarette smoking plays a role in an estimated 90 percent of these cases.

COPD has four stages. Your airflow becomes more limited with each passing stage. In addition to a reduced ability to breathe in and out fully, your symptoms can include a chronic cough and increased sputum production.

Different organizations may define each stage of COPD differently. However, most of their classifications are based on a lung function test known as the FEV1 test, which is your forced expiratory volume in one second. This test is expressed as a percentage and measures how much air you can let out during the first second of a forced breath. Being able to breathe becomes more difficult in later stages of COPD.

Stages of COPD

 Type 1

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the criteria for each COPD stage are as follows:

  • Stage 1, or mild COPD, happens when your FEV1 is equal to or greater than 80 percent. This can be with or without chronic symptoms, such as excess sputum, noticeable shortness of breath with exertion, and chronic cough.
  • Stage 2, or moderate COPD, happens when your FEV1 is between 50 and 79 percent. This can be with or without chronic symptoms.
  • Stage 3, or severe COPD, happens when your FEV1 is between 30 to 49 percent. This can be with or without chronic symptoms.
  • Stage 4, or very severe COPD, happens when your FEV1 is less than 30 percent. This is also known as end-stage COPD.

Doctors who specialize in lung diseases are called pulmonologists. They’re the most common doctors to treat COPD. Your pulmonologist may also use additional lung function tests to determine what stage of COPD you’re in. Treatments cannot reverse damage that’s already been done, but they can be used to try to slow down COPD’s progression.

Living with End-Stage COPD

home treatment

Quitting smoking is one of the best things you can do at any stage of COPD. Your doctor can prescribe medications to treat COPD that may also relieve your symptoms. These include medications known as bronchodilators. They help to widen your airways, making it easier to breathe.

You may also benefit from exercise training programs. Therapists for these programs can teach you breathing techniques that reduce how hard you have to work to breathe. This step won’t extend your life, but it will help enhance your quality of life.

You’ll be encouraged to eat small, high-protein meals at each sitting, such as protein shakes. This can enhance your well-being and prevent excess weight loss.

In addition to taking these steps, you should avoid or minimize known COPD triggers. For example, you may have greater difficulty breathing during extreme weather conditions, such as high heat and humidity or low temperatures and humidity. Conditions of low barometric pressure can also reduce the amount of oxygen in the air, making it harder to breathe.

Although you can’t change the weather, you can be prepared by limiting the time you spend outdoors during temperature extremes. Other steps you can take include the following:

  • Always keep an emergency inhaler with you but not in your car. Many inhalers operate effectively only when kept at a temperature between 50 and 80°F.
  • Wear a scarf or mask when going outside in cold temperatures to warm the air you breathe in.
  • Avoid going outdoors on days when the air quality is poor. The American Lung Association offers an app called “State of the Air” that’s available from Google Play or iTunes. The Environmental Protection Agency also updates air quality levels on Airnow.gov.

Palliative care or hospice care can greatly enhance your life when you’re living with end-stage COPD. A common misconception about palliative care is that it means someone will be dying soon. This is not the case. Instead, palliative care involves identifying treatments that can enhance your quality of life and help caregivers more effectively care for you. You can ask your doctor and insurance company for information about palliative care options.


Icon Outlook

In end-stage COPD you’ll likely need supplemental oxygen to breathe and you may not be able to complete activities of daily living without becoming very winded and tired. Sudden worsening of COPD at this stage, which is known as exacerbation, can be life-threatening. More than half of those with end-stage COPD whose FEV1 test is less than 35 percent will not survive beyond four years after this result.

However, the FEV1 test isn’t the only factor that affects your outlook. Your doctor will also take into account the following factors when determining the outlook:


Although being overweight is harmful if you have COPD, those with end-stage COPD are often underweight. This is because even the act of eating can cause you to become too winded. The result can be extreme weight loss that affects your overall health.

Shortness of Breath with Activity

Shortness of breath is also known as dyspnea. Shortness of breath with activity is the degree to which you get short of breath when walking. It can help determine the severity of your COPD.

Distance Walked in Six Minutes

The farther you can walk in six minutes, the less pronounced your COPD is.


The outlook is poorer for people with COPD who are older than 70 years old than it is for people with COPD who are younger than 70 years old.

Maintaining your quality of life is very important at this stage. There are lifestyle steps you can take, such as checking air quality and practicing breathing exercises. However, when your COPD has progressed, you may benefit from additional palliative or hospice care.

You Asked, We Answered

  • I’m interested in getting a humidifier for my COPD. Would this help or hurt my symptoms?
  • Neither the National Guideline Clearinghouse nor GOLD mentions the use of humidifiers. However, a humidifier may make mucous secretions thinner, which improves breathing. Humidifiers increase moisture in the air, making it a playground for bacteria and fungus. Make sure the humidifier has antibacterial and antifungal capabilities (silver ion or silver colloid). Also consider an air purifier with a HEPA filter to remove any pollutants that may trigger an increase in COPD symptoms.

    - Mark Laflamme, M.D.