Chronic obstructive pulmonary disease (COPD) is a progressive disease. The phases are classified according to how well a person's lungs work. The most severe level of the disease is end-stage COPD. At this stage, the person is likely to experience severe impairment of activity and daily functioning.
According to the National Heart, Lung, and Blood Institute, COPD is the third most common cause of death in the United States.
Medications and lifestyle changes are available to reduce symptoms, but they cannot ultimately stop COPD from progressing. Currently, there is no cure.
What is COPD?
Emphysema and chronic bronchitis and the two most common chronic obstructive pulmonary diseases (COPD).
COPD is a disease of the lungs. The lungs resemble two tree trunks because there are many branches leading off of them. These branches split into smaller branches or "twigs" that have air sacs - the tree's "leaves" - at their ends.
These sacs are where the exchange between air and carbon dioxide takes place. Carbon dioxide is a waste product that people release when they exhale.
Healthy air sacs are stretchy and easy to move. They work in a way that is similar to blowing up a balloon and letting the air out of it.
COPD can affect air exchange in the following ways:
- The air sacs lose their stretchiness, which affects their ability to open and close.
- The branches of the lungs become thickened, scarred, and inflamed.
- The airways secrete more mucus. The air sacs have difficulty opening and closing, which makes breathing harder.
Emphysema is a condition that causes damage to the air sacs. They may become less elastic, or smaller air sacs may be destroyed. The larger air sacs that remain may not work as well.
Chronic bronchitis causes excess mucus buildup, and a person's airways become thicker than normal.
Doctors classify COPD according to four stages. Stage IV, or end-stage COPD, is the most severe.
Spirometry is a test that can measure a person's lung function. A person blows into a handheld device that records how much air they can blow in and out.
A person with COPD cannot usually take in or blow out as much air as a person with healthy lungs.
These measurements can help a doctor to determine the severity of the person's COPD.
These measurements include:
A spirometry test may determine how severe the COPD is.
- FEV1: This measurement stands for forced expired volume in one second. The test measures how quickly a person can empty all the air that is in their lungs.
- FVC: This measurement stands for forced vital capacity. This is the maximum amount of air a person can exhale when they are trying to blow all the air out that they can.
- FEV1/FVC: This is a comparison of the two measurements. It lets doctors know how severe a person's COPD has become. A typical adult will have a ratio of between 70 and 80 percent. A ratio below 70 percent normally indicates COPD.
Common classifications for COPD include:
Stage I: Mild COPD The individual has a ratio of less than 70 percent. They may also have a chronic cough and cough up excess mucus. However, they may not notice that their lungs are not functioning normally.
Stage II: Moderate COPD The ratio is less than 70 percent and the FEV1 is between 50 and 80 percent. A person with moderate COPD will frequently become short of breath during activity. Symptoms may start to interfere with daily life, and the person will usually see a doctor about their breathing.
Stage III: Severe COPD The ratio is less than 70 percent and the FEV1 is between 30 and 50 percent. The symptoms of moderate COPD have worsened, and it may be harder to breathe and to exercise. There are severe airflow limitations, and a person is more likely to experience shortness of breath.
Stage IV: Very severe or end-stage COPD The ratio is less than 70 percent and the FEV1 is less than 30 percent. Sometimes, a person may have an FEV1 of under 50 percent, plus chronic respiratory failure. Particularly bad symptoms can be life-threatening.
Symptoms of end-stage COPD
A person with end-stage COPD is likely to have severe symptoms.
- Chronic cough
- Difficulty finishing a meal due to shortness of breath
- Sudden, acute exacerbations, or worsening, of the condition
- Frequent phlegm production
- Low blood oxygen levels if the person is not using additional oxygen
- Need for oxygen on a regular basis
- Shortness of breath, even with very moderate activity, such as walking to the mailbox
The goals for COPD treatment should be to engage in behaviors that reduce the chances of the disease progressing to end-stage COPD.
COPD is a chronic and progressive condition. Treatments for COPD may not prevent the progression of the disease, but they can relieve symptoms and make the condition easier to live with.
Complications include hypoxia when at rest - this occurs when oxygen saturation is too low to breathe effectively. Other problems include vulnerability to infections, acute exacerbations, confusion, and death.
Living with end-stage COPD
Avoiding smoking or being around smokers is recommended to reduce the exacerbation of COPD.
A person with end-stage COPD should take precautions to prevent their symptoms worsening. Each exacerbation can damage the lungs further, which will slow down recovery.
Ways to reduce the risk of exacerbation include:
- Avoiding exposure to secondhand smoke by not being around people who are smoking, not allowing others to smoke in the home, or not wearing clothes that smell of smoke.
- Quitting smoking, if this is not already done.
- Checking the air quality outdoors every day and avoiding those days that are excessively smoggy or affected by pollen. According to the World Health Organization, the most common causes of COPD exacerbations are infections and breathing in polluted air.
- Having a pneumonia vaccine and an annual flu shot.
- Seeking immediate treatment if there are signs and symptoms of an infection, such as fever and yellow- or green-tinged sputum.
- Taking prescribed medications, such as bronchodilators to keep the airways as open as possible, corticosteroids to reduce inflammation, and oxygen therapy.
Some people with COPD may have a lung transplant. According to the Cleveland Clinic, the 5-year survival rate following a single-lung transplant for COPD is 43.2 percent. A person must meet certain criteria, and there must be a compatible donor.
Because there is no cure for COPD, end-stage COPD can indicate a poor prognosis in terms of length of life.
Without breathing, a person cannot survive. A ventilator can help with breathing, but it cannot repair damaged lungs that can no longer take in enough oxygen to sustain life.
A severe infection, such as pneumonia, may leave the lungs unable to recover. The individual may also experience very high levels of carbon dioxide in their body. This can cause a person to experience confusion and delirium, and it can cause the blood to become acidic, which can be extremely dangerous.
A doctor can give a patient with end-stage COPD some idea about their life expectancy, as a number of factors will affect this.