Chronic obstructive pulmonary disease, or COPD, is a category of conditions that includes emphysema and chronic bronchitis. COPD is a progressive condition that gets steadily worse. Over time, the body becomes less able to take in enough oxygen. This can ultimately result in death.

According to the Centers for Disease Control and Prevention (CDC), chronic lower respiratory diseases — of which COPD is the most prevalent — were the "third leading cause of death in the United States in 2014."

Recognizing the end-stage symptoms of 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.

In this article, we cover the signs and symptoms that may indicate that a person is nearing the end of their life. We also discuss how to help people feel calmer and more comfortable during this stage of their life.

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There are four stages of COPD, which range from mild to end-stage.

COPD is terminal. People with COPD who do not die from another condition will usually die from COPD.

Until 2011, the Global Initiative for Obstructive Lung Disease 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 normal 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 episodes, the impact of COPD on a their life, and other factors.

The stages of COPD are as follows:

  • Mild, or stage 1: FEV1 is above 80%. A person's symptoms are mild, and they might not even notice that they have the condition.
  • Moderate, or stage 2: FEV1 is 50–80%. A person may notice a chronic cough, excess mucus, and shortness of breath.
  • Severe, or stage 3: FEV1 is 30–50%. A person may have a chronic cough and struggle 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.

There are two ways to measure end-stage COPD. Clinical symptoms are those that testing at a doctor's office can reveal.

These symptoms can include:

  • low blood oxygen, or hypoxemia
  • hypoxia, which is 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 will get a little better between flare-ups, they tend not to return to their previous condition.

Therefore, 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
  • confusion or memory loss due to oxygen deprivation
  • fatigue and increased sleepiness
  • frequent severe flare-ups
  • more frequent trips to the hospital
  • longer hospital stays
  • anxiety or depression
  • changes in consciousness
  • trouble swallowing
  • twitching or muscle weakness
  • changes in the way a person breathes, or their pattern of breaths
  • 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. In fact, within 5 years of diagnosis, COPD is also an independent risk factor for sudden cardiac death.

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

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

Palliative care helps with pain and distress but will not treat the underlying condition.

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
  • complementary remedies, such as massage therapy

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 to make peace with death.

Hospice providers prioritize the well-being of the patient and their desire for a good death, rather than preserving life at all costs.

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, about spiritual matters, or whether they have lived a good life.

Some strategies that may help include:

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Coping strategies may include talking about emotions and attending support groups.
  • Talking about emotions: It is normal to feel angry, afraid, or both. Discussing these emotions may help the person feel some relief.
  • Discussing life or wishes with loved ones: People can talk to their family about the legacy they want to leave, the lessons they want to share, and the love they hope to leave behind.
  • Talking to people who have experience with death: Hospice providers, religious leaders, and other people who have watched many people die 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 to a religious leader about end-of-life rituals. Spiritual leaders can offer insight and advice, and they may share their perspective 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, they should make sure 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 by oneself. People can try seeking the help of a therapist who specializes in such situations. Support groups for terminal conditions may also help.

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

It is normal for people to feel afraid or angry, and those who are close to death should not feel ashamed of these emotions.

A compassionate medical team and supportive hospice care can help a person feel comfortable and comforted during this stage of their life.