End stage COPD. What comes to mind when you hear this term? If you are like most people, the term "end stage" implies an association with imminent death, or at best, grave disability that is leading up to it. But as we explore the term further, we will see that this is not always the case.
Defining End Stage COPD
By definition, "end stage" refers to "the last phase in the course of a progressive disease." Some believe the term may be carelessly applied to a disease when health care practitioners feel that they have done all they can do, medically, for a patient.The reality is, given that the 4-year survival rate of many Stage IV COPD patients is less than 20 percent, end stage COPD is a real term and a real problem. But, where, exactly, does end stage COPD fall in terms of COPD staging?
Understanding The Stages of COPD
According to the Global Initiative for Obstructive Lung Disease (GOLD), there are four stages of COPD:
- Stage I -- Mild COPD
- Stage II -- Moderate COPD
- Stage III -- Severe COPD
- Stage IV -- Very Severe COPD
Each stage is defined according to spirometry measurement of FEV1.
In terms of the GOLD guidelines, end stage COPD refers to being in the final stage of the disease, Stage IV, or Very Severe COPD. But are the majority of people diagnosed with Stage IV, Very Severe COPD bed-bound, on oxygen, with dyspnea so severe they can't even bend over without gasping for breath?
On the contrary, there are many people in Stage IV who take excellent care of themselves -- they eat right, exercise religiously, take their medications -- who are beating the odds and still enjoying life as we know it. But there are also many people in Stage IV who are gravely ill. Which group you fall into has to do with a number of factors that influence COPD life expectancy, including smoking history, level of dyspnea, fitness level, and nutritional status.
Treatment for End Stage COPD
Although surgical intervention may be an option, it is likely to benefit only a small number of COPD patients. For some, as severity of disease increases, the focus of treatment begins to shift away from prolonging life to that of providing palliative care to relieve COPD symptoms.
If you are facing a diagnosis of end stage COPD, your doctor may prescribe the following treatment:
- Bronchodilators -- Both short and long-acting are recommended if dyspnea during regular activity is not relived by short-acting bronchodilators alone.
- Opiates -- Morphine in particular may significantly improve dyspnea; however, some studies show it may have serious side effects and benefits only a select number of patients.
- Inhaled glucocorticoids -- May be prescribed for patients with a FEV1 under 50% predicted and a history of repeated COPD exacerbations.
- Supplemental oxygen -- This reduces breathlessness caused by activity and improves exercise tolerance in patients with low blood oxygen levels.
- NIPPV -- This may lesson carbon dioxide retention and improve shortness of breath in some patients, but is not routinely recommended.
- Pulmonary rehabilitation -- This has been proven to benefit COPD patients at all stages of disease.
- Nutritional counseling -- This may be suggested as malnutrition is a common complication in end stage COPD and increases the risk of death.
- Psychological and social support -- These are an important aspect of treatment, as many patients do not discuss end-of-life issues with their doctors.
If your disease has not yet advanced, there are several things that you can incorporate into your lifestyle to maintain optimal health. Here are just a few:
First and Foremost: Quit Smoking
Smoking cessation remains the single most important, cost-effective way to prevent and treat COPD. If your goal is to feel better, slow the progression of the disease, and live longer, then you have no choice but to say goodbye to cigarettes once and for all.
- Complete Guide to Quitting Smoking
- Smoking Cessation: 10 Tips to Help You Quit
- List of Stop Smoking Aids
- Quit Smoking Success Stories
Exercise is the Key
Besides quitting smoking, if you are going to make one lifestyle change after a diagnosis of COPD that will have the greatest impact on your life, you should consider a daily exercise program.
- Exercise Basics for COPD Patients
- The Benefits of Walking With COPD
- 4 Ways to Increase Your Flexibility
- Functional Fitness for COPD and Asthma
Remember: You Are What You Eat
Good nutrition should be the foundation from which to start your journey after a COPD diagnosis, or even if you've been diagnosed for years and are wanting to make positive lifestyle changes to help you feel better. It is an essential part of any disease management program and gives those with COPD the vital energy they need to breathe and fight infection.
- Guidelines for a COPD Diet
- Healthy Eating Tips for COPD Patients
- Saying Farewell to Sodium
- Too Thin? How to Increase Your Calories
Don't Forget to Stay Positive
Someone once said that life is 10 percent what happens to you and 90 percent what you do about it. Staying positive in the midst of a potentially life-shattering illness is difficult, but it is not impossible. It's all about developing some new coping mechanisms that will fit easily into your lifestyle.
- Dealing With the Emotional Effects of COPD
- Depression Medication and COPD
- 6 Tips for Planting a Healing Garden
- Dealing With Insensitive Comments
- Relaxation Tips for Stress Relief
Understanding end stage COPD and what you can do to prevent yourself from getting there starts with taking a long, hard look at yourself in the mirror and asking yourself one specific question: "Am I worth it?" The person who looks back at you will hopefully smile back and answer "Yes."
Sources:
Ambrosino N, Gherardi M, Carpenè N. End stage chronic obstructive pulmonary disease. Pneumonol Alergol Pol. 2009;77(2):173-9.
Ambrosino N, Simonds A. The clinical management in extremely severe COPD. Respir Med. 2007 Aug;101(8):1613-24. Epub 2007 Mar 26.
Global Initiative for Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of COPD. December, 2009.
