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How Many Stages of COPD are There? Understanding the 4 Stages of COPD

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition that makes breathing increasingly difficult over time. There are 4 stages of COPD and understanding these stages can help patients and caregivers manage symptoms, anticipate changes, and plan for the future. This article will discuss how to determine what stage of COPD you or a loved one is in, life expectancy at stage 4, when COPD is considered terminal, and how weight loss fits into disease progression.

What are the 4 stages of COPD?

COPD is classified into four stages based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The stages are determined using a breathing test called spirometry, which measures lung function by evaluating forced expiratory volume (FEV1).

  • Mild (Stage 1): Symptoms are minimal, and many people may not realize they have COPD. There may be occasional shortness of breath and a chronic cough with mucus production.
  • Moderate (Stage 2): Shortness of breath becomes more noticeable, particularly during physical activity. Coughing and mucus production increase, and many people seek medical attention at this stage.
  • Severe (Stage 3): Lung function significantly declines, leading to frequent breathlessness, fatigue, and exacerbations (flare-ups) that require medical treatment.
  • Very Severe (Stage 4, End-Stage COPD): Symptoms are debilitating, with extreme shortness of breath, reliance on supplemental oxygen, and limited ability to perform daily activities. Flare-ups can be life-threatening.

How do you tell what stage of COPD you are in?

The stage of COPD is determined by a combination of symptoms, lung function tests, and the frequency of exacerbations. Doctors use spirometry to measure the amount of air someone can exhale after a deep breath (known as FEV1):

  • Stage 1 (Mild): FEV1 is 80% or more of the predicted value.
  • Stage 2 (Moderate): FEV1 is between 50% and 79%.
  • Stage 3 (Severe): FEV1 is between 30% and 49%.
  • Stage 4 (Very Severe): FEV1 is less than 30% or less than 50% with chronic respiratory failure.

A healthcare provider can assess symptoms, perform lung function tests, and evaluate the frequency of flare-ups to determine which of the 4 stages of COPD a patient is in.

What is the life expectancy of someone with stage 4 COPD?

Life expectancy with stage 4 COPD varies depending on age, overall health, smoking history, and the presence of other medical conditions. Studies suggest that individuals with very severe COPD may have a life expectancy ranging from a few months to a few years, with an average of about 2 to 5 years. However, factors such as oxygen therapy, pulmonary rehabilitation, and lifestyle changes can improve quality of life and potentially extend survival.

Consider also that hospice care can help at the end of life. Far from giving up, hospice is used to help COPD patients and their loved ones make the most of the time that remains.

When Is COPD considered terminal?

COPD is considered terminal when treatments no longer effectively manage symptoms, and the disease severely limits life expectancy. This often includes:

  • Repeated hospitalizations for exacerbations
  • Oxygen dependence with low blood oxygen levels
  • Severe weight loss and muscle wasting
  • Increased episodes of respiratory failure
  • Palliative and hospice care discussions become necessary

At this stage, the focus shifts to comfort care, symptom management, and quality of life.

What stage of COPD do you start losing weight?

Weight loss often begins in Stage 3 (Severe COPD) and becomes more pronounced in Stage 4 (Very Severe COPD). This typically occurs due to increased energy demands from labored breathing, reduced appetite, and systemic inflammation. Unintentional weight loss and muscle wasting (cachexia) are indicators of disease progression and can worsen outcomes. Nutritional support is essential to maintaining strength and improving overall well-being.

If you’re working with a hospice provider, a nurse can help pinpoint which of the 4 stages of COPD the patient may be experiencing.

How hospice can help with COPD.

Hospice care provides compassionate support for patients with end-stage COPD, focusing on comfort, symptom management, and emotional well-being. Hospice teams can help by:

  • Managing breathlessness, anxiety, and discomfort
  • Providing oxygen therapy and medications to ease symptoms
  • Offering emotional and spiritual support to patients and families
  • Assisting with advance care planning and decision-making
  • Coordinating in-home care to reduce hospital visits and improve quality of life

Hospice care ensures that patients receive the dignity and comfort they deserve in their final months. Patients get to spend more time at home, less time in hospitals, and as a result can maximize their time spent with loved ones. Often families indicate that they wish they’d called hospice sooner.

How Crossroads can help.

At Crossroads Hospice & Palliative Care, we specialize in providing tailored care for patients with advanced COPD. Our experienced team offers:

  • Personalized care plans to address breathing difficulties and symptom relief
  • 24/7 support from nurses and healthcare professionals – call us instead of making an ER visit
  • Emotional and spiritual counseling for both patients and families
  • Assistance with medications, medical equipment, and comfort care
  • Support for caregivers to help them navigate the challenges of COPD care, including options for respite

If you or a loved one is facing end-stage COPD, Crossroads is here to provide the care, guidance, and comfort needed during this time. Contact us via any of the methods at the top of this page to learn more about how we can help, including getting a patient assessment.