A doctor pointing to a lung scan on a tablet.
COPD can be a progressive disease and there are four different stages.

Understanding COPD Stages and Symptom Progression

COPD involves progressive damage to the air sacs in the lungs that leads to several respiratory symptoms, including trouble breathing. The tiny air sacs in the lungs lose their elasticity, which makes it difficult for the exchange of oxygen and carbon dioxide in the lungs. In addition, inflammation and excess mucus also develop.

According to the American Lung Association, most cases of COPD are due to cigarette smoking. So, what are the 4 stages of COPD? Let’s find out.

Symptoms of COPD

Symptoms of COPD typically include the following:

  • Wheezing
  • Breathlessness
  • Chest tightness or pain
  • Coughing

How is COPD Staged?

COPD is progressive, which means it gets worse over time. The rate in which the disease progresses is different for everyone. Doctors divide COPD by stage. There are four stages. Stage 1 is the mildest stage and 4 is the most advanced.

There are different staging symptoms. But many doctors use the Global Initiative for Obstructive Lung Disease (GOLD) system to determine a person’s stage of the disease. The GOLD system bases the COPD stage on the results of the forced expiratory volume test (FEV1). It measures the volume of air a person can blow out in one second.

COPD Stages

The four stages of COPD, including their main symptoms and treatment options include:

Stage 1 (Mild COPD)

The FEV1 is 80% or more of what a healthy person would get. Airflow limitations are mild.

Symptoms of stage one COPD may include:

  • Mild shortness of breath
  • Increased mucus
  • Wheezing

Since symptoms of COPD are mild, treatment may only be needed when wheezing, or chest tightness develops. Treatment for stage one COPD may include:

  • Fast-acting bronchodilators: Fast-acting bronchodilators are medications that open up the airways quickly, such as Albuterol. People with stage one COPD may only use inhalers once in a while when symptoms flare.
  • Stop smoking: One of the most vital ways to treat mild stage COPD is to stop smoking. Quitting smoking will not reverse the damage already done to the lungs. But it can prevent further damage, which might slow the progression of the disease.

Stage 2 (Moderate COPD)

The FEV1 results are 50% to 80% of normal. In stage two, symptoms may be more severe and occur more often. Most people realize they have a problem at this stage.

In addition to the symptoms experienced in stage one, symptoms may also include:

  • Persistent cough
  • Shortness of breath with light activity
  • Thicker mucus

Treatment for stage two COPD usually includes fast-acting bronchodilators, stopping smoking and a few additions things, including:

  • Long-acting bronchodilators: Long-acting bronchodilators work similar to fast-acting, but they last longer. Some work on different receptors in the lungs to keep the airways open for 12 hours or more.
  • Mucus clearing devices: As COPD progresses, mucus may become thicker, and the amount may also increase. A mucus clearance device is a handheld piece of equipment that you exhale into. It delivers vibration to the airways to help break up mucus, so it is easy to cough out.
  • Pulmonary rehab: Pulmonary rehab classes are great at any stage of COPD. But in stage one, people may not feel they need the classes. By stage 2, it is essential to learn ways to manage the disease. Pulmonary rehab classes provide information on how to deal with symptoms and prevent flareups.
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Stage 3 (Severe COPD)

The FEV1 is 30% to 50% of normal. Stage 3 COPD is considered severe. Symptoms are noticeable day to day and often interfere with a person’s quality of life.

In addition to the symptoms that occur in the previous two stages, symptoms may also include:

  • More severe breathlessness
  • Decreased oxygen levels
  • Increased carbon dioxide levels
  • Fatigue
  • Swelling of the feet
  • Anxiety

Treatment for stage 3 COPD may include the same things as stage 1 and 2 and the following:

  • Steroid inhalers: Steroid inhalers help reduce swelling in the lungs. If symptoms are not well controlled with other treatments, steroids may be added.
  • Oxygen therapy: By stage 3 COPD, some people cannot get enough oxygen into their lungs. Supplemental oxygen may be needed. Using oxygen therapy increases the amount of oxygen in the lungs and the rest of the body.

Stage 4 (Very Severe COPD)

The FEV1 results in people who are stage 4 are 30% or less of normal. This is the worse stage of COPD and is sometimes called end-stage. But that term is misleading since people with end-stage COPD can live for many years. But at this stage, symptoms are more severe, and flare-ups are more often.

In addition to the symptoms above, people with stage four COPD may also have:

  • Frequent respiratory infections
  • Headaches
  • Trouble maintain weight
  • Shortness of breath even at rest
  • Extreme fatigue
  • Sleepiness

Treatment for stage four COPD includes the treatments for the other stages, and possibly the following:

  • Antibiotics: People with stage four COPD may get frequent respiratory infections, which are treated with antibiotics.
  • Oral steroids: Oral steroids help decrease inflammation in the airways. They are stronger than just using a steroid inhaler.
  • BiPAP: BiPAP is a machine that delivers pressure to the airways during inhalation and exhalation. It helps people with COPD get carbon dioxide out of their lungs and also improves oxygen levels.