End stage chronic obstructive pulmonary disease (COPD), also referred to as stage 4 COPD, is the most severe stage of the condition. It can cause symptoms such as difficulty walking, frequent lung infections, and more. Some coping methods may help.

Recognizing the symptoms of end stage COPD can help a person cope and say goodbye to loved ones, make peace with their life, seek hospice care, and discuss their final plans.

This article looks at the signs and symptoms of end stage COPD. It also discusses how to help people feel calmer and more comfortable during this stage of their life.

There are two ways to measure end stage COPD: clinical symptoms and flare-ups.

Clinical symptoms are those that testing at a doctor’s office can reveal. These symptoms can include:

  • hypoxemia, or low blood oxygen
  • hypoxia, or low oxygen in the body’s tissues
  • cyanosis, a bluish hue to the skin due to oxygen deprivation
  • chronic respiratory failure, which occurs when the respiratory system cannot take in enough oxygen or release enough carbon dioxide

During late stage COPD, a person tends to experience more severe flare-ups. They may need to stay in the hospital during these flare-ups. Although a person may improve a bit between flare-ups, they tend not to return to their previous state of health.

A person’s health becomes steadily worse with each flare-up, and each flare-up tends to be worse than the last.

Some other symptoms a person might notice in late stage COPD include:

  • severe limitations in physical activities, including difficulty walking
  • shortness of breath
  • frequent lung infections
  • difficulty eating
  • unexplained weight loss
  • confusion or memory loss due to oxygen deprivation
  • fatigue and increased sleepiness
  • anxiety or depression
  • changes in consciousness
  • trouble swallowing
  • twitching or muscle weakness
  • changes in the way a person breathes
  • increasingly loud breathing

Although COPD is terminal, people may not always die of the condition directly or of oxygen deprivation.

Some people with COPD have other medical conditions, particularly cardiovascular disease. COPD is also an independent risk factor for sudden cardiac death within 5 years of diagnosis.

Learn more about end stage COPD.

Many treatment options are available to help a person with end stage COPD cope with the pain and discomfort associated with the condition.

Palliative care

Many people with terminal conditions find significant help from hospice care. Hospices provide end-of-life care that focuses on helping the person feel comfortable, easing their discomfort, and supporting them so they can make peace with death.

Hospice professionals prioritize the well-being of the individual, rather than preserving life at all costs.

Some palliative care options include:

  • help with daily activities, such as getting dressed
  • medications to relieve pain
  • blowing air into the face to help with breathlessness
  • medication for anxiety, depression, or insomnia
  • mind-body therapies, such as yoga

Although supplemental oxygen and COPD medications may help, they may not be as helpful as they were in the earlier stages of the condition.

Palliative care helps with pain and distress. However, it will not treat the underlying condition.

Learn about hospice criteria for COPD.

Coping strategies

For some people, anxiety about death is more painful than the physical discomfort of COPD. A person might worry about their legacy or their family, spiritual matters, or whether they have lived a good life.

Some strategies that may help include:

  • Talking about emotions: A person may feel angry or afraid. Discussing these emotions may help the person feel some relief.
  • Discussing life or wishes with loved ones: People can talk with their families about the legacy they want to leave, the lessons they want to share, and the love they hope to leave behind.
  • Talking with people who have experience with death: Hospice professionals may have a different perspective on death than family and friends. People can try talking through their emotions with them.
  • Religious rituals: If a person is religious, they can consider talking with a religious leader about end-of-life rituals. Spiritual leaders can offer insight and advice, and they may share their perspectives on spiritual matters.
  • Getting affairs in order: If possible, people with end stage COPD should ensure that their will is up to date. If they hope to leave something to their loved ones, it is a good idea to make sure that the relevant people know this. If the person has young children, they may want to appoint a guardian.
  • Support groups and therapy: The emotions associated with being near the end of life can be overwhelming and too significant to process alone. People can try seeking the help of a therapist who specializes in such situations. Support groups for terminal conditions may also help.

Learn more about managing COPD.

Until 2011, the Global Initiative for Obstructive Lung Disease (GOLD) assessed the severity and stage of COPD using only forced expiratory volume in 1 second (FEV1).

FEV1 is a measure of how much air a person can exhale in a single breath. When it falls below 30% of the usual amount, a person may be in the end stages of COPD.

The new standard also looks at shortness of breath, as well as a person’s history of acute COPD exacerbations, the effect of COPD on their life, and other factors.

The stages of COPD are as follows:

  • Mild, or stage 1: FEV1 is 80% or above. A person’s symptoms are mild, and they might not even notice that they have the condition.
  • Moderate, or stage 2: FEV1 is 50–79%. A person may notice a chronic cough, excess mucus, and shortness of breath.
  • Severe, or stage 3: FEV1 is 30–49%. A person may have a chronic cough and be unable to exercise or do daily activities. They may also feel tired or sick.
  • End stage, or stage 4: FEV1 falls below 30%. This is the final stage of COPD, and it will severely affect a person’s daily life.

GOLD guidelines also use the ABE assessment tool, which is based on how many exacerbations they experience per year and the number of symptoms they have.

Group A and B refer to zero to one exacerbations per year, without hospital admission. Group E refers to two or more exacerbations per year, or at least one exacerbation that leads to hospitalization.

Learn about how COPD progresses.

Here are some frequently asked questions about end stage COPD.

How long does end stage COPD usually last?

According to the nonprofit organization Lower Cape Fear LifeCare, around half of people with end stage COPD will be alive after 2 years.

However, it is important to note that the outlook will differ for each individual. A person’s doctor can provide them with more information about what they can expect and if any treatments can help.

How do you know if your COPD is getting worse?

As COPD progresses, a person may experience more severe flare-ups. They may also need to stay in the hospital, and hospital stays may lengthen as symptoms worsen. A person may also find that it becomes more difficult to resume their previous activities after each flare-up.

What to do when someone with COPD cannot breathe?

If a person is unable to breathe, it is important to seek immediate medical help.

If a person is experiencing shortness of breath, some techniques may help. These include breathing slowly, breathing through pursed lips, and using a rhythm to pace breathing.

End stage COPD, or stage 4 COPD, can be overwhelming. Seeking appropriate palliative care can help with the physical discomfort of COPD.

A compassionate medical team and supportive hospice care can help a person feel comfortable and comforted during this stage of their life. They can also recommend coping strategies to help a person manage symptoms.

Read this article in Spanish.