A older person breathing into a breathing device.
End-stage COPD is stage 4 COPD, when the condition has progressed to its worst.

Understanding End-Stage COPD Symptoms

Chronic obstructive pulmonary disease (COPD) is the term used for diseases that cause progressive damage to the lungs. COPD includes chronic bronchitis and emphysema.

Healthy air sacs in the lungs are elastic, which allows them to fill up with air when you inhale and deflate when you exhale. In people who have COPD involving emphysema, the air sacs lose their elasticity, which impairs air going in and out. In people who have chronic bronchitis, their airways become swollen and inflamed, which also prevents proper airflow.

According to the Centers for Disease Control and Prevention, in the U.S., about 16 million people have COPD. Although genetic factors and exposure to air pollution can lead to COPD, the main cause is cigarette smoking.

What Is End-Stage COPD?

COPD is categorized by stages. There are four stages that range from mild to very severe. Stage four is considered very severe and is also sometimes called end-stage COPD.

COPD staging is determined through the severity of symptoms and diagnostics testing. The Global Initiative for Obstructive Lung Disease (GOLD) is one widely used staging system.

COPD stage is determined based on a pulmonary function test, specifically the forced expiratory volume test (FEV1). The FEV1 is a measurement of the amount of air a person can exhale in one second. People with end-stage COPD are usually only able to blow out about 30% of the predicted amount of air for someone their age, height and gender.

End-Stage COPD Symptoms

Symptoms of COPD may be mild at first and progress over time. During any stage of COPD, symptoms of COPD include:

  • Chest tightness
  • Wheezing
  • Cough
  • Shortness of breath

When COPD progresses into end-stage, symptoms may become worse due to increased carbon dioxide levels and chronic low oxygen levels. Symptoms of end-stage COPD may include:

  • Clubbing of the fingers
  • Trouble breathing even at rest
  • Headaches
  • Recurrent lung infections
  • Extreme fatigue

Causes of End-Stage COPD

COPD is a progressive disease. The rate at which it progresses varies. Certain factors may speed the progression and contribute to the development of end-stage COPD. For example, continuing to smoke will likely make COPD progress faster and develop into more advanced stages.

In some cases, having a respiratory infection may cause an increase in the severity of the disease. Some people never return to their baseline after the infection clears. Instead, symptoms of COPD remain very severe.

People who are non-complaint with their treatment plan and do not take medications as prescribed or follow other recommendations may also progress faster and develop end-stage COPD.

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End-Stage COPD Treatments

Some of the same treatments used in milder stages of COPD are also prescribed for end-stage COPD. But there may also be additional treatments based on the increase in the severity of symptoms.

Quitting Smoking

Regardless of the stage of COPD a person has, quitting smoking is vital to manage symptoms. Continuing to smoke will cause COPD to progress faster and will make symptoms worse. Quitting will not reverse the damage already done to the lungs, but it can improve quality of life for people with end-stage COPD.

Breathing Treatments

Breathing treatments are common in any stage of COPD, but they become more frequent in end-stage COPD. Most people with end-stage COPD do breathing treatments multiple times a day. Breathing treatments for end-stage COPD may include fast-acting bronchodilators, such as albuterol, which open the airways quickly to reduce sudden symptoms.

Long-acting bronchodilators may also be prescribed. This class of medication also dilates the airways. But it takes longer to work and lasts longer.


It is common for people with end-stage COPD to develop frequent infections. Infections, such as pneumonia, can be severe for people with COPD. Some types of lung infections are treated with antibiotics.


Inflammation in the lining of the airways occurs with COPD. By the time a person has end-stage COPD, the inflammation or swelling is often severe. Steroids, which reduce inflammation, are often part of a treatment plan for end-stage COPD. Steroids may be prescribed through an inhaler and taken daily to reduce the frequency and severity of symptoms. Oral steroids are also sometimes prescribed to treat a COPD exacerbation.


It is common for people with end-stage COPD to have trouble expelling carbon dioxide from the lungs. Air becomes trapped in their lungs due to the damage to the air sacs. BiPAP is bilevel positive airway pressure delivered to your airways to help improve oxygen levels and decrease carbon dioxide levels.

Supplemental Oxygen

Low oxygen levels can develop due to COPD. Decreased oxygen can cause increased fatigue, shortness of breath and sleepiness.

Supplemental oxygen may help improve blood oxygen levels and quality of life. There are various devices designed for home use, including small tanks, concentrators and portable units.

Mucus-Clearing Devices

Mucus is often a problem in any stage of COPD. But by end-stage, it may be thick and hard to cough out of the lungs. Additionally, some people with very severe COPD are weak and do not have a strong cough to effectively expel the mucus. A mucus clearing device can help. There are various types of devices, including a therapy vest and handheld devices. The devices all work similarly by delivering vibration to the lungs, which helps you cough more efficiently.