What to Expect From End-Stage COPD or Stage IV
With contributions from Eric Patterson.
It is estimated that approximately 65 million people worldwide have moderate to severe chronic obstructive pulmonary disease (COPD) – and this number will only continue to rise over the next 50 years.
In the United States, approximately six percent of our population carries a diagnosis of COPD – this equates to approximately 15 million Americans. As many as 12 million Americans may have COPD and not know it. It is a costly disease – it costs the U.S. approximately $30 billion in healthcare dollars annually.
What Is End-Stage COPD?
COPD is a chronic, irreversible lung condition. Its hallmark symptom is breathlessness. It is an umbrella term for the following progressive lung conditions: emphysema, chronic bronchitis, and refractory asthma.
- Emphysema affects the tiny sacs of the lungs (alveoli). The alveoli become damaged and stretched out; thus the lungs become larger making air exchange more difficult. “Old” air gets trapped in the alveoli, and “new” air is unable to be exchanged.
- Chronic bronchitis causes inflammation to the breathing tubes (bronchial airways) of the lungs. This happens because the cilia, the tiny hair-like structures that line the airways, are unable to sweep the mucus. The lungs become swollen with mucus, and airflow becomes obstructed.
- Refractory asthma is a specific type of asthma that is unresponsive to asthma medications. During a typical asthma attack, certain medications can be used to open the airways when the bronchial airways are tightened; with refractory asthma, the airways do not respond to these medications.
COPD is typically a combination of these chronic lung conditions. When COPD reaches stage 4, it is also termed “end-stage.” We will discuss the symptoms and the stages of COPD later in the article.
Symptoms of End-Stage COPD
Symptoms of end-stage COPD are similar to that of COPD in general but intensified. These symptoms are more frequent and more severe – and are more likely to require treatment from a healthcare professional.
Common symptoms of COPD include:
- A chronic cough
- Shortness of breath that makes it difficult to perform activities of daily living, such as finishing a meal
- Phlegm production
- Worsening exacerbations
- Low blood oxygen levels without supplemental oxygen
- A need for supplemental oxygen
- Confusion due to low oxygen levels
Symptoms of end-stage COPD may include:
- Rapid heartbeat
- Swelling in the upper and lower extremities
- Weight loss
- A loss of musculature
- An increased difficulty breathing and speaking
- Cyanosis – a blue tinge to the lips and nail beds
- A loss of mental alertness
Stages of COPD
As with other chronic conditions, physicians stage COPD to determine the severity of the condition. This helps because then any provider who cares for you will know what your baseline functioning is.
There are two ways to stage COPD – the GOLD Staging System and the BODE Index.
The Global Initiative created the GOLD Staging System for Chronic Obstructive Lung Disease; it utilizes the forced expiratory volume in one second (FEV1) measurement from a pulmonary function test, then places you in stages. Other symptoms are also considered.
The BODE Index stands for the following: Body mass, Obstruction of airflow, Dyspnea, and Exercise capacity. The BODE Index is used to evaluate the effect on everyday living and the severity of symptoms.
The general stages for COPD are as follows:
- Stage 1 (mild COPD) – an FEV1 about 80 percent or more of normal. People with mild COPD may not even realize that they have COPD yet, but slight symptoms are beginning to develop, such as a cough and phlegm development.
- Stage 2 (moderate COPD) – an FEV1 between 50 and 80 percent of normal. An increase in cough and mucus production has developed. At this stage, people begin to seek assistance with their symptoms.
- Stage 3 (severe COPD) – an FEV1 between 30 and 50 percent of normal. Symptoms begin to worsen and begin to impact daily living. Fatigue begins to develop, have difficulty exercising, and require increased medications to function.
- Stage 4 (end-stage COPD) – an FEV1 lower than stage 3, or those with a stage 3 FEV1 and low blood oxygen levels. Flare-ups of COPD can become life-threatening. Oxygen therapy may be required.
Treatment for End-Stage COPD
There are a variety of medications that can be used to treat COPD:
- Bronchodilators are inhaled and work by relaxing the muscles of the airways. They make breathing easier. There are short-acting bronchodilators that are used when symptoms are acute or before activities or long-acting bronchodilators that are used daily (tiotropium, salmeterol, formoterol).
- Inhaled steroids reduce inflammation of the airways. They also prevent exacerbations. They are extremely helpful for people who have frequent COPD exacerbations. However, there are more frequent side effects with inhaled steroids, such as bruising, hoarseness, and oral infections. Examples include fluticasone and budesonide.
- Combination inhalers combine bronchodilators and inhaled steroids, thus have the benefits of both types of medications. Examples include salmeterol and fluticasone and formoterol and budesonide.