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End Stage COPD

Understanding What the Term End Stage COPD Means


Updated July 02, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

After reading this article, you will have an opportunity to share what bothers you most about the term "end stage COPD."

End stage COPD. What comes to mind when you hear this term? Many people associate the term "end stage" with imminent death or grave disability that's leading up to death. But as we explore the term further, you may be surprised to learn that this isn't always the case.

Defining End Stage COPD

By definition, "end stage" refers to "the last phase in the course of a progressive disease." Some people think the term is carelessly applied to a patient when health care providers feel that they've done all they can do, medically, for a patient. Given that the 4-year survival rate of many Stage IV COPD patients is less than 20 percent, the reality is that 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 GOLD guidelines, end stage COPD refers to being in the final stages of the disease; Stage IV, or Very Severe COPD. But are the majority of people diagnosed with end stage COPD gravely ill? 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 still able to function relatively well with few limitations. There are also many people at this stage who are very sick. 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.

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.

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.

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.

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."


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.

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