What to Know About the Four Stages of COPD

Jul 20, 2023


Alto Pharmacy

Chronic obstructive pulmonary disease (COPD) is a progressive and long-term inflammatory lung condition characterized by a persistent cough and shortness of breath. While COPD is caused by smoking 85-90% of the time, exposure to secondhand smoke, air pollution, and industrial dust and fumes also contributes to cases. It’s the third leading cause of death in the U.S. and affects more than 15 million Americans.

Detecting COPD early on is critical to slowing the progression of the disease and avoiding serious complications. Doctors use a system called the GOLD Criteria to determine how severe each person’s COPD is. There are four distinct stages of COPD: mild, moderate, severe, and very severe. Your physician will determine your stage based on results from a breathing test called a spirometry, which assesses lung function by measuring how much air you can breathe in and out and how quickly and easily you can exhale. They will also consider the severity of your symptoms and the frequency of flare-ups.

As a progressive lung disease, COPD symptoms gradually become more severe over time, and people with COPD also grow increasingly susceptible to complications such as heart problems, pulmonary hypertension, and lung cancer. But while there is no cure for the condition, it is treatable: you can slow the progression by working with your doctor to establish a treatment plan and maintaining healthy lifestyle habits like avoiding cigarette smoke, exercising regularly, eating a healthy diet, and getting your yearly flu shot.

Read on to learn more about the stages of COPD, including the symptoms and treatment options for each stage.

Stage 1: Mild COPD

The main symptoms of stage 1 COPD are shortness of breath and an ongoing cough, which may be accompanied with mucus. However, these symptoms are so mild that you may not realize you are experiencing them. 

Though stage 1 COPD symptoms are easy to miss, damage to the lungs still occurs. If you have any concerns that you may have COPD, speak with your doctor about an assessment. And if you currently smoke, try to quit as soon as possible to protect your lungs.

In addition to smoking cessation, your doctor may also prescribe a bronchodilator medication, which relaxes airway muscles to ease breathing and is typically taken through an inhaler. Common side effects include dry mouth, dizziness, tremors, runny nose, and throat irritation. If you experience severe side effects like blurry vision, a rapid or irregular heart rate, or an allergic reaction with a rash or swelling, contact your healthcare provider.

You should also stay up to date with yearly flu shots and pneumonia vaccines to avoid worsening of respiratory symptoms and other health complications.

Stage 2: Moderate COPD

In this stage, previously existing symptoms from stage 1 intensify as airflow limitations progress. Shortness of breath during physical activities is more noticeable, and coughing and mucus production may increase. Other symptoms include wheezing, fatigue, and trouble sleeping.

This is often the stage where you may first become aware of symptoms and seek treatment. Your doctor may prescribe a bronchodilator medication if they haven’t already, along with recommending breathing exercises. Techniques like pursed lip breathing and coordinated breathing can help you exert yourself less during physical activities and maintain an active lifestyle.

In addition to your medications, pulmonary rehabilitation is another common component of treatment for stage 2 COPD. It gives people living with COPD the tools they need to manage their condition, reducing the severity of symptoms and improving their quality of life. At these outpatient exercise and education programs, physical therapists, dietitians, nurses, and other healthcare professionals will share breathing techniques, coping strategies, nutritional advice, and exercise recommendations. Your doctor can help you determine if pulmonary rehabilitation is right for you.

The frequency of your doctor’s appointments depends on the severity of your condition. If symptoms are mild, you may have follow-up appointments every six months, while more severe symptoms will require more frequent monitoring.

Stage 3: Severe COPD

At stage 3, lung function has significantly decreased. As the walls of the air sacs in the lungs continue to weaken, it becomes more difficult to take in oxygen and remove carbon dioxide while exhaling.

Previous symptoms are more intense and more noticeable: shortness of breath has worsened, coughing or wheezing occurs more frequently, and you may produce thicker mucus.

You may also experience the following symptoms:

  • Extreme fatigue or weakness

  • Feelings of confusion or forgetfulness

  • Swelling of the ankles, feet and legs

  • Tightness in the chest

  • More frequent chest infections

In this stage, you may experience flare-ups when symptoms suddenly become more severe and lung function dramatically changes. During these exacerbations, you may feel greater amounts of mucus clogging your bronchial tubes and sudden constrictions of the muscles around your airways.

Flare-ups are the leading cause of COPD-related hospitalizations, and it’s important to take immediate action if you experience symptoms of a flare-up. Watch out for the following signs:

  • Breathlessness or shortness of breath

  • Increase in coughing attacks

  • Wheezing or whistling noises when you breathe

  • Increase of mucus

  • Fatigue or sleep problems

  • Cognitive impairment including confusion, depression, or memory lapses

As part of your COPD treatment, your doctor will help you develop an action plan for managing flare-ups, including medications. Oral steroids including prednisone, methylprednisolone, and dexamethasone can treat acute COPD exacerbations. Side effects from short-term use of these medications are typically minor, if they occur. 

If you have frequent flare-ups, your doctor may prescribe inhaled corticosteroids including Flovent® HFA and Qvar Redihaler®; expectorants, which thin and loosen mucus; or oxygen therapy. You may also need to see your doctor every two weeks to a month for ongoing monitoring of symptoms.

Stage 4: Very Severe COPD

In stage 4 of COPD, lung function is very low. Stage 3 symptoms worsen and become more persistent. Shortness of breath and chest tightness occur with everyday activities, and it becomes a big effort just to breathe. Hospitalizations for breathing complications, lung infections, or respiratory failure are common during stage 4 COPD, and sudden flare-ups can be life-threatening.

Other symptoms of stage 4 COPD include:

  • A crackling sound when you breathe in

  • Barrel chest

  • Delirium

  • An irregular or fast heartbeat

  • Weight loss

  • Pulmonary hypertension, a form of high blood pressure that affects the arteries in your lungs and the right side of your heart

There are various treatment options for severe COPD symptoms, including supplemental oxygen, pulmonary rehabilitation, and steroids taken orally, intravenously, or via inhaler. Potential side effects from steroids include swelling in the airways and mouth, muscle weakness, weight loss, fatigue, and increased risk for pneumonia. Read our previous blog to learn more about managing medication side effects, and speak with your doctor if you have questions or concerns.

Supplemental oxygen, or oxygen therapy, helps get more oxygen into your lungs and increases your tolerance for physical activities. There are several devices for oxygen therapy. The most common is a nasal cannula, a device with two small tubes that fit into your nostrils and a connected oxygen tank. Adjusting to supplemental oxygen is a process, but you’ll come to feel more and more comfortable with time. The American Lung Association has helpful resources for anyone starting oxygen therapy.

Lung surgery or lung transplants are also options for some people with severe COPD. Eligibility is based on many factors, including participation in a pulmonary rehabilitation program, lung function tests, and additional considerations such as whether you are strong enough for the procedure and if you smoke. (You cannot be a current smoker for lung surgery eligibility.) Your doctor can help you determine if lung surgery is right for you.

Early Detection and Smoking Cessation

Detecting and treating early-stage COPD is essential to slowing the progression of the disease. If you are experiencing any early warning signs like shortness of breath and a persistent cough, make an appointment with your doctor to determine what’s causing your symptoms. Early COPD screening is especially important if you smoke since you face a greater risk of developing this lung disease.

Many people struggle with quitting smoking, so don’t be afraid to ask your doctor for resources that can help, including nicotine replacement products or medications. The CDC has a variety of smoking cessation resources to help as well.

Get the treatment you need to slow the progression of COPD

Sticking to the treatment your doctor has recommended is critical to avoiding COPD flare-ups and slowing the progression of the disease. At Alto, we make that as easy as possible by offering fast and reliable delivery, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions directly through our easy to use in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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