Living with stage 4 chronic obstructive pulmonary disease (COPD) can feel like an uphill battle, but many MyCOPDTeam members encourage each other to keep up the fight. “Don’t give up. There’s so much we can do to manage our symptoms, keep moving, and stay strong,” wrote one member.

Keep reading to understand more about stage 4 COPD, including potential outcomes and treatments. For more specific advice about your COPD, ask your care team about what you can do to manage your symptoms.

What Does Stage 4 COPD Mean?

COPD is a progressive disease that’s classified into four stages, each representing a phase of the disease. People with COPD are often staged at the time of their diagnosis based on their spirometry test, which measures forced expiratory volume (FEV1), or the amount of air you can breathe out in one second. This measurement tells your doctor how blocked your airways are.

Your doctor may also look at other pulmonary (lung) function tests, your history of exacerbations (flare-ups), symptoms, and other health conditions to help stage your COPD as follows:

• Stage 1 — Mild or no symptoms, FEV1 80 percent or higher
• Stage 2 — Moderate symptoms, FEV between 50 percent and 79 percent
• Stage 3 — Severe symptoms, FEV1 between 30 percent and 49 percent
• Stage 4 — Very severe symptoms, FEV1 lower than 30 percent

Stage 4 is also considered end-stage COPD. People in this stage tend to have worse flare-ups that may need emergency care.

Symptoms of Stage 4 COPD

Stage 4 COPD is associated with more severe symptoms that may affect your quality of life. These include:

• Constant shortness of breath, even at rest
• Frequent, possibly life-threatening flare-ups
• Low energy and difficulty completing everyday activities
• Muscle loss and general weakness
• Issues from hypoxemia (low blood oxygen), including gray or blue-tinted lips, depending on your skin color

Many people also experience mental health challenges, including anxiety and depression. One MyCOPDTeam member reported frequent mood swings. “I remind myself I’m not overreacting. Instead, I tell myself that it’s totally understandable to feel scared and frustrated,” they wrote. If you can relate, ask your doctor for mental health resources to help you cope.

“I remind myself I’m not overreacting. Instead, I tell myself that it’s totally understandable to feel scared and frustrated.”

— A MyCOPDTeam member about their stage 4 COPD

While these symptoms are common at stage 4, they don’t apply to everyone. Someone can be in stage 4 but show mild to moderate symptoms. Your doctor can help you understand your stage if it’s unclear.

Understanding the Outlook for End-Stage COPD

The outlook for people with stage 4 COPD varies. While COPD’s lung damage is permanent, there are many ways to manage symptoms — and, in some cases, improve them. With early treatment, people can live for decades. People with stage 4 COPD have a life expectancy that is six to nine years shorter on average, but it’s not always considered a life-ending illness.

That said, people with stage 4 COPD are at higher risk for hospital stays and other complications, so it’s important to protect your lung health by:

• Having a plan for when flare-ups happen, like taking certain medications
• Avoiding smoking or being around secondhand smoke
• Limiting exposure to chemicals or dust that can further irritate or damage your lungs
• Staying inside on days with high pollution/poor air quality
• Avoiding people who are sick with colds
• Following your treatment plan as directed by your care team

Since people with COPD are more likely to develop respiratory (lung) infections, consider getting your flu, COVID-19, and pneumococcal pneumonia vaccines to prevent severe exacerbations.

One MyCOPDTeam member reported taking additional precautions to prevent illness, which has helped them over the past three years. “My husband and I avoid large groups and people who are sick. We wear masks when we go out. We also wash our hands a lot or carry hand sanitizer,” they wrote.

“My husband and I avoid large groups and people who are sick. We wear masks when we go out. We also wash our hands a lot or carry hand sanitizer.”

— A MyCOPDTeam member on preventing illness with COPD

Treating Stage 4 COPD

Treatment strategies for stage 4 COPD depend on your symptoms, lung function, and any overlapping health conditions you may have. The treatments described below are common at this stage but may not apply to you. Always talk to your doctor to create a plan that works for you.

Medications

Your healthcare provider may prescribe an inhaler or nebulizer with bronchodilators to help open your airways, or steroids to reduce inflammation. They may also prescribe a round of corticosteroids to help control symptoms during flare-ups.

If you frequently experience bacterial infections, your healthcare provider may also prescribe antibiotics to treat them and reduce the risk of infection-triggered flares.

Oxygen Therapy

People with end-stage COPD usually have difficulty getting enough oxygen from their lungs. Low oxygen levels increase the risk of other conditions, including chronic respiratory failure and cardiac complications. A doctor may prescribe supplemental oxygen to prevent these conditions.

Oximetry and arterial blood gas tests both measure oxygen saturation (the amount of oxygen in the blood). Your doctor can measure oxygen saturation at rest, during activity, or while asleep to find out how much oxygen you need and which oxygen devices can help.

Pulmonary Rehabilitation

Pulmonary rehabilitation can help you learn exercises, disease management techniques, and nutrition strategies for your COPD. Consistent attendance may help increase your lung function, reduce symptoms, and improve your quality of life. Talk to your doctor about joining a program.

Many MyCOPDTeam members — of different abilities and COPD stages — find pulmonary rehabilitation sessions helpful. “I’ve been going for 11 years. I now have stage 4 COPD, and I’ll still go and exercise for as long as I can. I have to stay active, and I feel like I’m doing really well,” wrote one member.

Another member was also thankful for their rehabilitation sessions. “I’ve learned that the biggest thing you can do is exercise. I’m getting in better shape, and I feel more capable and more comfortable doing everyday things,” they wrote.

Breathing Support

Some people may need extra breathing support to improve their oxygen levels. Noninvasive ventilation is a type of breathing support that uses a mask connected to a machine to help people breathe more easily. The machine controls air pressure going through your airway, which helps air move to and from your lungs.

Your doctor may prescribe a continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) machine for home use, typically if you also have obstructive sleep apnea. BiPAP machines are also useful for people who have difficulty exhaling enough carbon dioxide, a waste product of breathing. Some MyCOPDTeam members use these machines, especially at night. “I got my first one 10 years ago. I went from getting a couple of hours of sleep a night to getting a full nine hours. It just took a while to get used to wearing the mask,” they wrote.

People with COPD often experience breathing difficulties due to trapped air in the diseased part of the lung. Endobronchial valve (EBV) therapy is another breathing support option for severe COPD stages that can help trapped air escape and improve shortness of breath during everyday activities. To get EBVs, you’ll undergo a minimally invasive procedure that places the removable, one-way valves in the affected areas of your lungs. Most people spend two or three nights in the hospital.

Surgery

Some people with stage 4 COPD may have severe symptoms, like constant breathlessness, that need surgery to improve. You could be a candidate for surgical options if you’re strong enough to go through the recovery process, go to pulmonary rehab regularly, and don’t smoke. Lung surgery can result in fewer symptoms, but there’s always a risk of complications. Your doctor can help you weigh the pros and cons if you’re considering surgical options.

Two types of surgery for end-stage COPD include:

• Bullectomy — A surgery where one or more damaged air sacs in the lungs are removed to help improve air flow
• Lung volume reduction surgery (LVRS) — A procedure that removes the upper lobes of the lungs, or about 30 percent of diseased tissue, to help the healthier areas work better

People who aren’t candidates for LVRS, have had three or more severe flares within the last year, or have lung damage that can’t be repaired by other surgeries may be candidates for a lung transplant. This is a major operation that replaces damaged lungs and comes with big risks, like organ rejection (when the body doesn’t accept the new lungs) or taking immune-suppressing medications daily. But it can help improve your quality of life.

Palliative Care

Palliative care focuses on relieving discomfort, pain, anxiety, and stress related to COPD. It’s available as soon as you’re diagnosed with any stage.

Specialists can help improve your quality of life by offering support where you need it. They may offer medications to help treat mental health challenges, teach relaxation techniques, or guide you in lifestyle changes.

Join the Conversation

On MyCOPDTeam, people share their experiences with COPD, get advice, and find support from others who understand.

What treatments have helped your stage 4 COPD? Let others know in the comments below.