What to Expect in Stage IV or End-Stage COPD

When you reach Stage IV, or end-stage COPD, lung damage is usually extensive, COPD symptoms are more severe and quality of life is often gravely impaired. Although the lung damage caused by the disease cannot be reversed, treatment can help manage symptoms and in some cases, extend life. Let’s find out more about end-stage COPD and how it can be treated and prevented.

Symptoms of End-Stage COPD

stage iv copd, stage 4 copd, end-stage copd, end stage copdShortness of breath, coughing, increased mucus production, fatigue – many of the symptoms you experienced in earlier COPD stages are likely to worsen once you reach Stage IV COPD. Whereas once you may have had shortness of breath only during exercise, now you may have it even at rest. In the earlier stages of the disease, you may have had only one or two COPD exacerbations (flare-ups) per year. Now your flare-ups occur more frequently. Other symptoms you may notice may include:[1]

  • Lung crackles – a crackling noise heard upon inspiration (breathing in).
  • Increased wheezing – a high-pitched whistling sound when you breathe in or out.
  • Barrel chest – a condition that occurs because the lungs have been chronically over-inflated with air causing the rib cage to remain partially expanded at all times.
  • Increased difficulty when eating and exercising – at this stage, shortness of breath may interfere with all activities, including eating and exercising.
  • Decreased muscle strength and energy – as COPD symptoms worsen, activity levels tend to decrease causing muscles to become deconditioned and weak and energy levels to decrease.
  • More frequent lung infections – common in the advanced stages of the disease.
  • Increased risk of co-existing illnesses – such as arthritis, asthma, diabetes and stroke.
  • Chronic respiratory failure – when your lungs don’t move enough oxygen into your blood or they don’t remove enough carbon dioxide, prolonged respiratory failure can occur, increasing your chances of disability and premature death.

Diagnosis of End-Stage COPD

As with other stages of COPD, the end-stage of the disease is primarily diagnosed with a lung function test known as spirometry. With Stage IV, very severe COPD, your forced expiratory volume in one second (FEV1) will be less than 30 percent. To test for chronic respiratory failure, your doctor may also perform an arterial blood gas (ABG) study and a pulse oximetry test.

Treatment of End-Stage COPD

Depending upon the severity of your symptoms, your doctor may prescribe the following treatments for end-stage COPD:[2]

  • Inhaled bronchodilators to relax and widen the airways making it easier to breathe.
  • Inhaled corticosteroids to reduce inflammation and irritation in the airways, easing breathlessness.
  • Opiates have been found to increase oxygenation and significantly improve breathing in end-stage COPD, but because of the potential for serious side effects, they only benefit a small number of patients.
  • Supplemental oxygen reduces breathlessness associated with activity and improves exercise tolerance in patients with low blood oxygen levels. Also improves survival when used more than 15 hours per day.
  • Non-invasive positive airway pressure (NIPPV) such as CPAP may lessen carbon dioxide retention common in this stage and improve shortness of breath in some patients.
  • Pulmonary rehabilitation has been found to be beneficial in all stages of COPD.
  • Nutritional counseling is suggested during this stage because of the high-risk of malnutrition which increases the risk of death from COPD.
  • Complementary therapies such as relaxation and visualization, massage and music therapy may help ease symptoms and soothe the soul.

Prevention of End-Stage COPD

If your disease has not yet advanced to end-stage COPD, the following lifestyle changes are recommended to prevent further lung function decline and preserve optimal health:2

  • Smoking cessation – the single most important way to treat and prevent COPD. Studies show that quitting at any stage can benefit lung disease, slowing its progression and sometimes even adding years to your life.
  • Exercise – besides quitting smoking, a daily exercise program will have the greatest impact on a COPD diagnosis.
  • Healthy diet – good nutrition is an essential part of COPD management providing you with the extra energy you need to breathe.
  • Positive outlook – developing new coping mechanisms will help you stay positive despite a diagnosis of end-stage COPD.

NOTE: while some people with Stage IV, end-stage COPD are gravely ill, others are still able to live a relatively comfortable life. Where you fall along the spectrum depends upon your smoking history, fitness level, severity of dyspnea (shortness of breath) and nutritional status.

For more information about end-stage COPD, talk to your primary care provider or pulmonologist.

[1] WebMD. Stage IV (Very Severe) COPD. Last review February 17, 2018.

[2] Ambrosino, N, et al. End-Stage Chronic Obstructive Pulmonary Disease. Pneumonol Alergol Pol. 2009;77(2):173-9.


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