Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that causes narrowing of the airways. Chronic bronchitis and emphysema are the two types of COPD. Before your doctor can develop a COPD treatment plan to help you breathe more easily, they need to assess your COPD stage.

The treatment regimen may be different for someone in the early stages compared to those in later-stage COPD. Knowing the stage at diagnosis also helps doctors track how the disease is progressing and decide whether to recommend a change in treatments.

Here are facts about the four stages of COPD that you can discuss in more detail with your pulmonology team.

How Is COPD Staged?

COPD staging usually occurs at the same time that COPD is diagnosed. It may also be reassessed as the disease progresses, or gets worse, over time. There are two main approaches for determining COPD stages.

GOLD Stages of COPD

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) system is based on the results of a spirometry test. This is one of the pulmonary function tests your doctor will perform during the diagnosis process. It measures the speed and strength of your exhalations (when you breathe out).

To pinpoint a GOLD stage, doctors look at forced expiratory volume (FEV1), which assesses the amount of air exhaled through a spirometer in a one-second interval. They also review forced vital capacity (FVC), which measures how much total air you exhale.

BODE Stages of COPD

The Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity (BODE) index assesses COPD’s impact on daily life and predicts estimated life expectancy. To calculate your BODE score, your doctor measures your body mass index (BMI), lung function, oxygen levels, and performance on a six-minute walk test.

What Are the 4 Stages of COPD?

Based on your test results, you’ll be diagnosed with stage 1, 2, 3, or 4. Later stages have more severe COPD symptoms and lower quality of life.

Stage 1: Mild

Stage 1 COPD is mild and may not cause any symptoms. Many people in stage 1 don’t even realize they have COPD. The most common symptoms are a dry cough with very little phlegm and shortness of breath when exercising. According to the GOLD system, people with stage 1 COPD usually have about 80 percent of normal lung function.

To treat stage 1 COPD, your doctor may suggest that you make lifestyle changes. If you smoke, they’ll advise you to quit smoking. If you don’t smoke, they may recommend avoiding secondhand smoke and fumes. Your pulmonologist might also suggest using a bronchodilator medication. These drugs are inhaled to open the lungs’ airways. They often come in the form of inhaler devices but can also be used in nebulizer machines.

Stage 2: Moderate

Stage 2 COPD is moderate. People are more likely to see their doctor at this stage due to symptoms such as:

• Chronic cough
• Persistent phlegm production, which may be worse after waking up
• Fatigue (tiredness that doesn’t get better with rest)
• Sleep issues
• Worsening shortness of breath
• Wheezing
• Mental health changes, such as confusion or a bad mood

About 20 percent of people at stage 2 experience COPD exacerbations (periods of symptom worsening) that lead to changes in phlegm color.

Based on the GOLD system, people with stage 2 COPD usually have 50 percent to 79 percent of normal lung function.

To treat stage 2 COPD, your doctor may recommend short-acting or long-acting inhalers. They also might suggest trying pulmonary rehabilitation therapy to help manage symptoms. These approaches are used in addition to the strategies you may have considered during stage 1.

Stage 3: Severe

Stage 3 COPD is severe, and symptoms occur every day. At this stage, most people see an impact on their quality of life because daily activities get harder. Stage 3 symptoms include:

• Wheezing during daily tasks
• Frequent flare-ups (periods when symptoms worsen)
• More colds or chest infections than in the past
• Chest tightness during everyday activities
• Swollen feet, ankles, and legs

According to the GOLD system, people with stage 3 COPD usually have 30 percent to 49 percent of normal lung function.

To treat COPD in stage 3, you may keep using the same medications as in stages 1 and 2. Most people in the third stage also use oxygen therapy to make breathing easier. During an exacerbation or flare-up, your doctor may prescribe antibiotics to treat any respiratory infections.

Stage 4: End-Stage

Stage 4 COPD is considered very severe and may be referred to as end-stage COPD. At this stage, most people have trouble getting enough oxygen. Quality of life is significantly affected, and flare-ups can be life-threatening. Symptoms in stage 4 include:

• Increasing effort to breathe, even when resting
• Crackling sounds when breathing in
• Fast or irregular heartbeat
• Weight loss
• More severe or frequent flare-ups

In the GOLD system, stage 4 COPD includes those with less than 30 percent of normal lung function remaining.

Treating stage 4 COPD may include all the therapies used in prior stages. For people who are candidates for surgery, doctors may recommend a few options, including lung volume reduction and endobronchial valve replacement. Some people may be candidates for a lung transplant at this stage.

What Is the Longest Someone Has Lived With Stage 4 COPD?

There’s no statistic demonstrating the longest survival for someone with stage 4 COPD, but one study showed that people with severe COPD usually live about eight to nine years less than people without the condition. However, with early treatment, many people with COPD live for decades.

Each case of COPD is unique, and some take years to progress. There’s no fixed timeline of COPD progression. Although there’s no cure for COPD, several treatment options can help limit disease progression and slow down lung damage. Not everyone who has COPD dies from the condition.

Talk with your doctor about your prognosis. They can help you determine whether COPD is likely to impact your life expectancy and work with you on a plan to manage symptoms and improve your quality of life.

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