What Are the Stages of COPD?

COPD stands for chronic obstructive pulmonary disease. This disorder is characterized by decreased airflow to and from the lungs. It is a progressive respiratory condition that can impact your ability to breathe properly. When you develop COPD, your body receives less oxygen than it needs to function properly. 

What causes COPD? People develop COPD for several reasons, but smoking is one of the most common causes. Exposure to air pollution, genetics, and early childhood respiratory infections can all increase your risk of developing the disease later in life.

You may not know that COPD occurs in four distinct stages. Each of these stages produces different symptoms, and the treatment approaches vary depending on the stage of the disease.

Stage One

The first stage of COPD is mild and produces very subtle symptoms, if any. During this stage, many people aren’t aware that they have COPD or that anything is wrong with their lung function. Some people mistake their symptoms for a simple flu or respiratory infection at this stage.

Symptoms

While symptoms are minor during the first stage of COPD, you may notice the following:

• Cough
• Increased mucus production
• Shortness of breath with moderate exertion

Often, stage one COPD is diagnosed through an incidental finding on a routine diagnostic exam. Your doctor can perform a spirometry test during a yearly physical and find that your lung function is abnormal. 

From there, they may order a pulmonary function test or PFT to assess your lung function with a FEV1 score. FEV1 measures your forced expiratory volume or the amount of air you breathe out when you exhale. In stage one, your FEV1 should be between 80 and 100 percent.

Treating Stage One COPD

In the first stage of COPD, your doctor may prescribe a bronchodilator as the first line of treatment. This is an inhaled medication that can help open up the airways and allow for increased airflow. They may also suggest lifestyle modifications, like quitting smoking and avoiding exposure to secondhand smoke.

Stage Two

Stage Two COPD is still relatively mild for most patients, but there is a slight increase in the severity and frequency of symptoms. Many people see a decrease in their activity levels and quality of life during this stage because their symptoms have become more noticeable and ongoing.

Symptoms

During the second stage, you can experience any combination of the following symptoms:

• Chronic cough
• Increased mucus production
• Shortness of breath with mild exertion

It is during this stage that most COPD patients are officially diagnosed because they seek an answer to their ongoing symptoms. 

Your primary doctor may perform a preliminary spirometry test before referring you to a pulmonologist for a pulmonary function test. In stage two, a PFT will typically reveal an FEV1 score of 50 to 79 percent.

Treating Stage Two COPD

Treatment becomes pertinent when you are in the second stage of COPD. Your doctor will likely prescribe a bronchodilator medication to provide increased airflow and open up the airways. Steroids may also be provided to help ease your symptoms during flare-ups. 

You may also start a pulmonary rehabilitation program. These programs are designed to further educate you on COPD and give you additional ways to manage the condition.

Stage Three

Stage three is considered to be the severe stage of COPD. It is during this stage that most patients find their quality of life significantly impacted, with a decreased ability to function. More extensive treatment methods are started during this time as the condition continues to progress in severity.

Symptoms

When you are in the third stage of COPD, you will likely experience the following symptoms and more:

• Chronic shortness of breath
• Continued coughing
• Excessive mucus production
• Frequent respiratory infections
• Chest tightness
• Pain or discomfort when taking a deep breath
• Wheezing
• Trouble getting a full breath
• Swelling in the ankles

During stage three of COPD, many people find it difficult to perform their activities of daily living. You may find yourself too out of breath to complete daily chores, work duties, and more. Most patients are unable to exercise to any extent and experience extreme lethargy from even short periods of physical activity. 

A pulmonary function test often shows the FEV1 to be at 30 to 50 percent during this stage.

Treating Stage Three COPD

Treatment options during stage three of COPD are very similar to stage two, but supplemental oxygen is added. You may also find yourself using prescription steroids more often due to frequent flare-ups or an increase in the severity of your symptoms. 

Stage Four

Stage four is the most pronounced and severe stage of COPD. When you are in this stage, your ability to function is significantly diminished. Blood oxygen levels will be low, and you are now at an increased risk of developing heart failure or lung failure. Most people are completely dependent on oxygen at this point.

Symptoms

Symptoms of stage four COPD are very pronounced and seriously impact your quality of life. Many patients experience:

• Difficulty breathing, even at rest
• Heart palpitations or tachycardia
• Wheezing
• Extreme mucus production
• Severely decreased airflow
• Intense lethargy and fatigue
• Inability to partake in any physical activity

In the fourth stage of COPD, you will experience frequent flare-ups that could be fatal if not immediately addressed. You will likely be entirely dependent on oxygen to get any oxygen intake. FEV1 readings at this stage are below 30 percent.

Treating Stage Four COPD

When you reach the fourth stage of COPD, extensive treatment options are required to maintain oxygen intake. Ongoing supplemental oxygen is necessary, and surgical intervention may be needed. These interventions include lung transplants or lung volume reduction surgery.

Seeking Treatment for COPD

From bronchodilators to surgical intervention, there are many ways to approach COPD in its different stages. In recent years, some patients have looked to regenerative medicine to alleviate COPD symptoms. 

If you are struggling with chronic obstructive pulmonary disorder at any stage, speak with your pulmonologist about alternative treatment options.