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Coping With End-Stage COPD
End-stage COPD is the most severe stage of chronic obstructive pulmonary disease. During this stage, symptoms worsen, and a flare could become life threatening.
Chronic obstructive pulmonary disease (COPD) is a progressive condition that affects a person's ability to breathe well. It encompasses several conditions, including emphysema and chronic bronchitis.
In addition to a reduced ability to breathe in and out fully, symptoms can include a chronic cough and increased sputum production.
Read on to learn about ways to ease end-stage COPD symptoms and factors that may affect your outlook if you have this condition.
End-stage COPD is the most severe stage of COPD. It's also called very severe COPD. During this stage, symptoms such as coughing and shortness of breath worsen and can become life threatening.
COPD has four stages, and your airflow becomes more limited with each passing stage. The stages of COPD are:
Your doctor may use guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to help determine which stage you're in.
The classifications are based on a number of factors, including:
A spirometry test assesses your lung function by measuring how much air you can breathe in and out of your lungs.
The result of this test is expressed as a percentage. It measures your forced expiratory volume (FEV1), which is how much air you can let out during the first second of a forced breath. It's compared to what is expected from healthy lungs of similar age.
The GOLD criteria uses FEV1 results to grade COPD as follows:
In addition to FEV1 results, the 2023 GOLD guidelines use symptom severity and number of exacerbations to further categorize people with COPD into groups labeled A, B, or E.
The groups are defined by the seriousness of symptoms, such as:
Exacerbations are periods when symptoms get noticeably worse. Exacerbation symptoms can include:
The groups are defined as:
If you have end-stage COPD, you have very little lung function left. The lack of oxygen can start to affect your heart and circulatory system. A COPD exacerbation during this stage could be life threatening.
End-stage COPD is marked by severe shortness of breath, even when at rest. At this stage, medications typically don't work as well as they may have in the past. Everyday tasks will leave you more breathless.
Other symptoms you experienced in earlier stages of COPD may also worsen. These include:
Additional symptoms and complications of end-stage COPD include:
In end-stage COPD, you'll likely need supplemental oxygen to breathe, and you may not be able to complete activities of daily living without becoming very winded and tired. Sudden worsening of COPD at this stage can be life threatening.
The outlook for end-stage COPD varies from person to person. Your outlook may depend on a number of factors, such as:
The BODE index is one tool your doctor may use to help determine your outlook. It measures:
Treatments for COPD can't reverse damage that's already been done, but they can be used to try to slow down the progression of the condition.
Treatment options for end-stage COPD are similar to those used in earlier stages of the condition. These may include:
The use of any of these treatments is likely to increase significantly from mild (stage 1) COPD to end-stage COPD.
Medications used to treat COPD and relieve your symptoms include bronchodilators, which help to widen your airways.
There are two types of bronchodilators:
Glucocorticosteroids may help reduce inflammation. These medications can be delivered to your airways and lungs with an inhaler or a nebulizer. A glucocorticosteroid is commonly given in combination with a long-acting bronchodilator for treatment of COPD.
An inhaler is a pocket-sized portable device, while a nebulizer is larger and meant primarily for home use. While an inhaler is easier to carry around with you, it's sometimes harder to use correctly.
Using a spacer with your inhaler can help ensure the medication gets deep into your lungs, where it works best. A spacer is a small plastic tube that attaches to your inhaler. The medication moves into the spacer, where it becomes a fine mist that can be inhaled more easily and more deeply into the lungs.
A nebulizer is a machine that turns a liquid medication into a continuous mist that you inhale for around 5 to 10 minutes at a time through a mask or mouthpiece connected by tube to the machine.
Pulmonary rehabilitation is a medical program that can help people with COPD and other lung diseases breathe easier. It can help people:
An individualized pulmonary rehab program may include:
Supplemental oxygen is typically needed if you have end-stage COPD. It involves receiving oxygen to increase the amount of oxygen that flows into your lungs. This can help you breathe easier.
You may receive oxygen through a nasal cannula or a face mask.
Surgery for advanced COPDYou may need surgery if you have very severe COPD or if other treatments aren't working.
There are several types of surgery that may be used to treat COPD. These include:
Speak with your doctor about the risks and benefits of each surgery and whether you may be a candidate.
In addition to receiving treatment, there are lifestyle changes you can make to help manage the symptoms of end-stage COPD.
These may include:
Maintaining your quality of life is very important during end-stage COPD. There are lifestyle steps you can take, such as checking air quality and practicing breathing exercises. When your COPD has progressed in severity, however, you may benefit from additional palliative care.
A common misconception about palliative care is that it's for someone who will be passing away soon. This isn't always the case. Palliative care can be beneficial and enhance quality of life at any stage of COPD, including end-stage COPD.
Palliative care involves identifying treatments that can help you manage the physical and emotional symptoms of COPD and help caregivers provide you with more effective care. The main goal of palliative care is to ease your pain and control your symptoms as much as possible.
You'll work with a team of doctors and nurses in planning your treatment goals and caring for your physical and emotional health.
Ask your doctor and insurance company for information about palliative care options.
COPD is a progressive condition that currently has no cure. At some point, you may need to begin preparing for end of life. Although this can be hard to think about or discuss, it's important to know what you may expect and to make decisions about practical matters regarding your care.
Talk with your loved ones and healthcare team about your medical choices for your end-of-life care. Having a plan can help ensure your wishes are followed and ease the burden on family members and loved ones.
You may wish to complete an advance directive. This is a legal document that provides instructions for your medical care in case you become severely ill or unable to communicate your decisions.
Common types of advance directives include:
When planning for end-of-life care, here are some questions you may wish to consider:
Caring for a loved one with end-stage COPD can be physically and emotionally challenging. These tips can help you support your loved one:
End-stage COPD is the most severe stage of COPD. During this stage, you may experience worsening dyspnea, coughing, sputum production, and fatigue.
Treatments such as medications, oxygen therapy, and surgery may help ease symptoms and slow the progression of COPD. Making lifestyle changes, such as avoiding smoking, can also help.
There's currently no cure for COPD, and the outlook varies from person to person. Seeking palliative or hospice care can provide comfort and help you manage symptoms of end-stage COPD.
You may also wish to create an advance directive that states your decisions regarding your medical care and treatment in the event you become seriously ill.
What Are The Complications Of COPD?
COPD can lead to elevated blood pressure in the arteries that carry blood from the heart to the lungs, a condition known as pulmonary hypertension.
"People with COPD often have low levels of oxygen in the blood, which is known as hypoxia," says Dr. Pistenmaa. "Over time, hypoxia can cause the vessels [between the heart and lungs and within the lungs] to constrict, which increases the pressure in those arteries." Eventually, even mildly low oxygen levels can lead to pulmonary hypertension, she adds.
Emphysema, which causes damage to the air sacs in the lungs, can also destroy small blood vessels in the lungs, which then increases pressure in other vessels.
With pulmonary hypertension, the right side of your heart has to work harder to move blood through the lungs. This can cause the right side of the heart to enlarge and ultimately fail, a condition called right-sided heart failure, or cor pulmonale.
As pulmonary hypertension progresses, other symptoms include:
Mild pulmonary hypertension typically doesn't require any treatments other than management of the underlying COPD, says Pistenmaa. That said, if your blood oxygen levels are low at rest or while exercising, supplemental oxygen may help reduce the stress on the heart.
If you develop moderate to severe pulmonary hypertension, you may need to take blood thinners and use oxygen therapy at home. In rare cases, people with severe pulmonary hypertension may need to undergo a lung or heart-lung transplant.
RELATED: 7 Ways to Ease Emphysema Symptoms
How To Avoid COPD Exacerbations/Flare-Ups
The problem with COPD is you have obstruction to air flow, so most patients have a chronic cough, have some shortness of breath, have some wheezing. And periodically they will have what we call an exacerbation, which is an acute worsening of the disease. So their cough will get worse, their shortness of breath will get worse,Thomas DeMarini, MD cont
their mucus production will get worse. These can be due to just the disease. They can also be due to an infection -- either a viral or bacterial infection. And the patients just get worse. COPD flare-ups to us are extremely serious because they are a marker that you are going to lose lung function.Thomas DeMarini, MD cont
In other words, each exacerbation makes your lungs a little bit worse. So when a patient comes to me who is diagnosed with COPD, my first issue is to get them off inciting experiences such as, smoking is the big one, but exposure to dust, chemicals, smoke fumes, non-specific respiratory irritants of all kind.Thomas DeMarini, MD cont
And once I reduce that source exposure, then my next thrust is to keep them from having exacerbations of their disease. What I usually tell patients to look for in a flare-up is: Is their mucus getting worse? Is there more of it? Is it changing color? Is it going from its usual pale white to a yellow or green sputum?Thomas DeMarini, MD cont
Is their cough getting worse? Are they having more coughing when they lay down? I also warn them that if they are having a fever, that's usually a sign that you're about to have an exacerbation. With some of our patients we use a little device called a peak flow meter that they can blow in every morningThomas DeMarini, MD cont
and see what their lung function looks like. And if that starts to fall down to 150 over several days, that's a certain sign they're going to have an exacerbation. But usually I tell the patients they will know when they're sick. The number one thing that you can do is avoid irritants,Thomas DeMarini, MD cont
and that specifically means you need to come off cigarettes. And the physician can assist you with that. I also tell patients if you're in a dusty occupation, you need to do what you can to avoid that dust and avoid the irritants. And then, it's been shown repeatedly that gentle exercise, aerobic exercise,Thomas DeMarini, MD cont
significantly improve patients' breathing and decreases the exacerbations. And there are a host of medications we can use now that barely existed or didn't exist at all 25 years ago that really improve the day-to-day function of patients with COPD so they can do the things that they want to do. That part of the treatment of the patient is highly individualThomas DeMarini, MD cont
and that's why most people who have severe disease end up at a lung specialist for us to be able to institute those medications.","publisher":"WebMD Video"} ]]>
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Thomas DeMarini, MD Pulmonologist
The problem with COPD is you have obstruction to air flow, so most patients have a chronic cough, have some shortness of breath, have some wheezing. And periodically they will have what we call an exacerbation, which is an acute worsening of the disease. So their cough will get worse, their shortness of breath will get worse,Thomas DeMarini, MD cont
their mucus production will get worse. These can be due to just the disease. They can also be due to an infection -- either a viral or bacterial infection. And the patients just get worse. COPD flare-ups to us are extremely serious because they are a marker that you are going to lose lung function.Thomas DeMarini, MD cont
In other words, each exacerbation makes your lungs a little bit worse. So when a patient comes to me who is diagnosed with COPD, my first issue is to get them off inciting experiences such as, smoking is the big one, but exposure to dust, chemicals, smoke fumes, non-specific respiratory irritants of all kind.Thomas DeMarini, MD cont
And once I reduce that source exposure, then my next thrust is to keep them from having exacerbations of their disease. What I usually tell patients to look for in a flare-up is: Is their mucus getting worse? Is there more of it? Is it changing color? Is it going from its usual pale white to a yellow or green sputum?Thomas DeMarini, MD cont
Is their cough getting worse? Are they having more coughing when they lay down? I also warn them that if they are having a fever, that's usually a sign that you're about to have an exacerbation. With some of our patients we use a little device called a peak flow meter that they can blow in every morningThomas DeMarini, MD cont
and see what their lung function looks like. And if that starts to fall down to 150 over several days, that's a certain sign they're going to have an exacerbation. But usually I tell the patients they will know when they're sick. The number one thing that you can do is avoid irritants,Thomas DeMarini, MD cont
and that specifically means you need to come off cigarettes. And the physician can assist you with that. I also tell patients if you're in a dusty occupation, you need to do what you can to avoid that dust and avoid the irritants. And then, it's been shown repeatedly that gentle exercise, aerobic exercise,Thomas DeMarini, MD cont
significantly improve patients' breathing and decreases the exacerbations. And there are a host of medications we can use now that barely existed or didn't exist at all 25 years ago that really improve the day-to-day function of patients with COPD so they can do the things that they want to do. That part of the treatment of the patient is highly individualThomas DeMarini, MD cont
and that's why most people who have severe disease end up at a lung specialist for us to be able to institute those medications.
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