Stages of COPD

Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that includes emphysema and chronic bronchitis. It’s most commonly caused by smoking, but not always.

“When we talk about COPD, we’re talking about small airways narrowing as a result of smoking-related lung injury,” says Constance Jennings, MD, pulmonologist, UPMC.

COPD is a progressive disease, meaning it gets worse and there is no cure. Symptoms can include shortness of breath, coughing, and poor lung function. Early detection is critical to getting the appropriate treatment and managing the disease. COPD also can increase the risk of developing heart disease and lung cancer.

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COPD Stages

The four stages doctors use to diagnose and treat COPD are:

Stage 1: Mild

At this stage, you may not know you have COPD. You may experience more coughing or increased mucus production. If you’re concerned that you may be developing COPD, your doctor may order a spirometry test to measure your lung function.

If you’re a smoker, quit immediately to slow the decline of lung function. Your doctor also may recommend breathing exercises or lifestyle changes to help manage symptoms.

Stage 2: Moderate

At this stage, most people have a cough, mucus, and shortness of breath. Some people pass these symptoms off as signs of aging or a cold. If you haven’t had a spirometry test, your doctor is likely to order one to determine if you need treatment.

Your doctor may recommend breathing exercises to help control your breathing and give you advice on how to avoid triggers that cause symptoms to worsen. You also may need to begin using a bronchodilator — a type of medication that opens the airways to help get more oxygen into your lungs.

Short-term bronchodilators include Albuterol, Ipratropium, and Levalbuterol.

Stage 3: Severe

At this stage, lung function has seriously declined. Symptoms are more pronounced, and you may have flare-ups when symptoms get worse. Your doctor will likely prescribe a long-acting bronchodilator and possibly steroids, expectorants, or oxygen therapy.

Bronchodilators are typically taken every day in the form of an inhaler. Some common long-acting bronchodilators are Arformoterol, Formoterol, Tioptropium, and Umeclidinium. Some inhalers are combination steroid-bronchodilators, such as Formoterol and budesonide called Symbacort or Salmeterol and Fluticasone in the Advair HFA and AirDuo Digihaler.

COPD can prevent the proper amount of oxygen from reaching your blood supply, so your doctor may recommend oxygen therapy. Oxygen therapy delivers oxygen to the lungs through a compact device that is easy to maneuver. Some people with COPD only need this treatment while active or sleeping; however, some require its assistance at all times.

Stage 4: Very Severe

At this stage, lung function is very low. You get winded with even small amounts of activity and symptoms flare-ups can be life threatening. Treatment at this point would build on your current therapies. Surgery may be needed to remove damaged areas of the lungs. In severe cases — where all other treatment options have failed — a lung transplant may be necessary.

If you have an increase in coughing or mucus, make an appointment with your doctor. The earlier you find out what’s causing your symptoms, the better your chances of starting treatment or making lifestyle changes that can slow the progression of COPD.

Surgery may be an option for some people with very severe COPD. The first option is lung volume-reduction surgery in which surgeons remove small wedges of damaged lung tissue from the upper lungs. This allows for extra space in the chest cavity to allow the remaining healthy lung tissue to expand and help the diaphragm work more efficiently.

A more damaged lung may require a bullectomy in which surgeons remove the bullae, or large air spaces, from the walls of the lungs to help improve air flow. The last surgery option is a lung transplant. This surgery carries numerous risks as it requires a pair of donor lungs and the replacement of the damaged lungs. Transplant can be a lifesaving surgery, but the recipient must take immune-suppressing medications to keep the body from fighting the donor lungs and the body may reject the donor lungs.

“The UPMC Center for COPD and Emphysema offers a broader array of therapies than available at most centers,” Dr. Jennings says. “We really emphasize an expanded array of therapies that go beyond the traditional therapies, focused at treating the patient as a whole person and addressing all the aspects of their health that may be impacting on their illness. Beyond that, we have advanced therapies for people with very severe disease.”

For more information, visit the UPMC Center for COPD and Emphysema.

Editor's Note: This article was originally published on , and was last reviewed on .

About UPMC

Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.