The 4 Stages of COPD: What You Need to Know


The 4 Stages of COPD: What You Need To Know


Being diagnosed with COPD can be a very frightening and disheartening experience. It's common to feel fear and apprehension about living with the diagnosis and maybe even guilt about what you did or didn't do that might have caused your COPD.

But the most important thing to understand about your COPD diagnosis is that, with an effective treatment plan and healthy lifestyle changes, you can take control and slow the progression of your disease.


According to the GOLD System (developed by the Global Initiative for Chronic Obstructive Lung Disease), COPD progresses through four typical stages, with Stage1 being the most mild and Stage 4 the most severe.


Based on your symptom severity and lung function tests (spirometry), your doctor will determine what stage your disease is at. GOLD also just released new guidelines that take your COPD assessment test score and your exacerbation history into account as well.


However, the most common practice used by doctors to classify stages of COPD is using your symptom severity and your lung function tests to determine your stage.


This article will introduce you to the 4 stages of COPD and what to expect at each point. We want to help you better understand your disease, your symptoms, and how to take care of yourself and stay as healthy as possible.


Some COPD patients feel helpless to control their disease, but the only way to slow COPD symptoms from worsening is to take a proactive role in your own health and treatment. With the help of their doctors and healthy lifestyle changes, many people with COPD live long, full, and active lives.


Take the COPD Athlete, Russel Winwood, for example. He has spent his life since his diagnosis living an extremely active lifestyle, and runs marathons and trains for triathlons despite having Stage 4 COPD.


He's used his own example to encourage others with COPD and other respiratory diseases to work hard and keep up hope. He is proof that you can maintain an active, high quality of living with enough effort and dedication.


And just because Russel is training for triathlons doesn't mean that's what you have to do to live a full and happy life. That's his passion and he doesn't let his COPD dictate his life. You can still follow your passion and live your life to the fullest too!




Stage 1: Mild COPD

COPD stage 1 is the first, most mild stage of the disease. In fact, the symptoms are usually so mild that most people don't realize that they have a health problem. Typically people think their symptoms are just signs of aging or long-term smoking because the symptoms aren't debilitating. They just brush them under the rug.


Woman coughing while man holds stethoscope to her back.


Unfortunately, this means that many people ignore the early symptoms of COPD and wait too long to go see a doctor. These are some of the warning signs that you might have COPD:


  • Constantly short of breath after simple tasks
  • Changes in the consistency and color of your mucus
  • Chronic cough for no apparent reason
  • Have a hard time breathing while laying down


If you experience any of these warning signs, it's important not to brush off mild respiratory ailments and see a doctor for advice as soon as possible. Catching the disease early is key so that you have time to take medications and make healthy lifestyle changes to prevent it from worsening.


At stage 1, COPD is still very treatable, so it's important to take advantage of all the available treatments and make lasting lifestyle changes. It's especially important to stay active and exercise regularly while your symptoms are still mild.


Stage 1 COPD Symptoms

COPD is often the last thing people consider when they have respiratory issues, but it's important to pay attention to your symptoms and consider any warning signs you might have.


Symptoms of COPD: coughing, fatigue, wheezing, and shortness of breath.


If you are or have been a smoker, have been exposed to lung irritants at home or work, or have had heavy exposure to other chemicals or pollutants, you need to be especially vigilant.


Here are the most common symptoms of Stage 1 COPD:

  • Slight airflow limitations
  • Chronic cough and/or wheezing
  • More mucus/sputum production in airways
  • Fatigue (you notice that you get tired more easily than usual)
  • FEV1 Value of at least 80% of normal (Your FEV1 is a measure of the amount of air you can exhale in 1 second)


As you can see, stage 1 COPD symptoms are easy to mistake for a benign condition like allergies, the common cold, or a natural part of aging. COPD can be tricky that way, and that's why it's important to take these symptoms seriously and talk to a doctor as soon as possible. Especially if your symptoms are persistent.


Stage 1 COPD Treatment Options

If you've been given a stage 1 diagnosis, you have a huge advantage when it comes to slowing the progression of your disease. The best time to diagnose COPD is at stage 1, because there is still plenty of time to make healthy lifestyle changes and you are still living a fairly normal and active life.


At stage 1, symptoms are usually very mild and most treatment options focus on prevention of further symptoms. By developing healthy lifestyle habits like eating clean, exercising regularly, and being social while also closely monitoring your symptoms, you will have a much easier time managing your COPD and slowing its progression.


Blue inhaler and other medical supplies on a table.


While COPD is not curable, it is very treatable. Your disease will likely progress to a later stage, but early treatment can greatly slow the disease's progression. These are some of the recommended treatment options for stage 1 COPD.


Quit Smoking

If you are a smoker, then the number one, most important important thing you can do to treat your COPD is to quit. As soon as you get your COPD diagnosis, you should seek out and utilize whatever smoking cessation resources are available to you.


Quitting smoking is certainly not easy, but if you have COPD, it's the only way to prevent your health from rapidly declining. If you don't quit immediately, you will almost certainly see your symptoms get quickly and permanently more severe.


Don't be afraid to ask for help. Talk to your doctor about smoking cessation medications, and enlist your friends and family for support. There are even government and state programs that will give you nicotine patches or gum for free by signing up for their program.


But I'm not going to beat a dead horse here... There are so many articles on quitting smoking and I'm sure you've heard all of the tips more than once.

I will leave you with one little piece of advice that might not be listed. Join Facebook support groups. You will be able to connect with people who are going through the same battle as you and people who have successfully quit so you have numerous people to rely on for support.


Avoid Lung Irritants

Quitting smoking is one part of avoiding lung irritants, but there are other chemicals and air conditions that you should also avoid if you have COPD.


If you have allergies, you already know that it can affect your airways and ability to breathe. But dust and pollution are lung irritants as well, and you should avoid them to prevent your COPD symptoms from flaring up.


Pollution above a factory.


Even if you don't notice your symptoms getting worse from dust and smog, they could still be causing damage to your lungs and should be avoided. The more total exposure you have to these lung irritants, the more quickly your disease will progress.


Key lung irritants to avoid:

  • Air pollution and smog
  • Dust (consider using an air filter or dust mask in places you might be exposed)
  • Pollen (if you have allergies)
  • Chemicals found in household (and industrial) cleaning products
  • Strong perfume or cologne (including other scented products like lotions and shampoos)
  • Smoke (including secondhand smoke, incense, burning wood, etc.)
  • Aerosols (like air fresheners and disinfectants)
  • Extreme weather conditions (extreme heat, extreme cold, and  humidity)


Healthy Diet & Nutrition

It's important to start making changes to your diet as soon as you get your diagnosis, because it can do wonders for your overall health. And when you have COPD, it's especially important to keep your body in the best possible shape.


Your doctor will help you work out a diet that's tailored to your needs, depending on your age, current diet, disease stage, and other factors. Make sure not to make any major, sudden changes to your diet without consulting your doctor first.


Here are some foods that are healthy for people with COPD:

  • Choose lean proteins (chicken, fish, turkey)
  • Eat plenty of fruits and vegetables
  • Eat whole grains and avoid processed foods
  • Take necessary vitamins and supplements as recommended by your doctor
  • Drink plenty of water and avoid sugary drinks (like soda and fruit juices)


These are recommendations that any healthy adult, not just people with COPD, should follow. But as someone with COPD, it's especially important for you to avoid unhealthy foods and give your body the proper nutrition it needs.


Here are some foods that are not healthy for people with COPD:

  • Fried and processed foods (e.g. fast food, processed snacks, and processed meats)
  • Caffeinated and sugary beverages
  • Foods high in salt
  • Foods that cause heartburn or acid reflux
  • Nitrates and sulfites
  • Alcoholic beverages (they can slow your breathing rate)


Get More Physical Activity

Developing good exercise habits as soon as possible is extremely important if you have COPD. The longer you wait, the worse your symptoms will get. If you can build good exercise habits while you're still at stage 1—when symptoms are still mild—it will be easier to remain physically activity as time goes on.


If you wait until a later stage, you'll find that the worsened symptoms like coughing, wheezing, and restricted airways make it especially difficult to stick with an exercise routine. It will be even worse if you haven't ever been very active before.


Even though you might feel winded and have difficulty breathing at times, it will get easier as you build strength. But it's important that you don't over do it. If you feel like you can't keep going, that's okay. Just keep trying and your whole body will feel stronger and healthier. Not to mention, you'll have more energy and endurance.


Man and woman with COPD going on a hike.


Not only is exercise good for you overall, regular cardiovascular activity can actually strengthen the muscles around your lungs. This can help lessen your COPD symptoms, making it easier to breathe.


Here are some of the benefits you can get from following an exercise plan with COPD:

  • Improved circulation and oxygen delivery throughout your body
  • Improved oxygen efficiency (your lungs won't have to work as hard to deliver enough oxygen)
  • Stronger muscles around your lungs
  • A boost to your immune system
  • More energy and endurance


Get Vaccinated

People with COPD are more prone to complications when they get sick with the flu or other viruses. Getting a respiratory illness could lead to exacerbations of existing symptoms.


Vaccinations won't help reduce any of the symptoms you already have, but it can help keep them from getting worse. A bad flu can cause COPD troubles to flare up and linger, sometimes causing a permanent worsening of symptoms.


Since COPD patients have a higher risk of complications and hospitalizations, it's especially important that they protect themselves from respiratory illnesses like Pneumonia and the flu. By keeping up with your yearly vaccinations, you'll have an extra layer of protection against this risk.


Short-Acting Bronchodilators

At stage 1, there is usually minimal, if any, medication required to control symptoms. Breathing issues are usually mild, and long-term medication is not usually necessary.


That said, the first prescription medication most people with COPD get is one for a short-acting bronchodilator. This kind of inhaler is meant to be used on-demand, when you need temporary relief from mild symptoms.


Short-acting bronchodilators contain a medication that relaxes the muscles around your lungs and makes it easier to breathe. Most doctors will instruct you to use them as needed when your symptoms flare up.


Here are a couple examples of short-acting bronchodilator medications:

  • Anticholinergics (e.g. ipratropium)
  • Beta 2-agonists (e.g. albuerol or levalbuterol)
  • Sometimes your doctor will prescribe a combination of two short-acting bronchodilators


Overview of Stage 1

While a COPD diagnosis is never good news, if you're diagnosed at stage 1, you are luckier than most with the disease. You still have many viable treatment options ahead of you and the opportunity to improve your overall health before your symptoms worsen.


Little, if any, medication is needed at stage 1, and your treatment plan will likely focus on preventative maintenance and healthy habits like diet and exercise. It's also important to avoid environmental irritants like secondhand smoke, household chemicals, and prolonged exposure to allergens.


You can greatly improve your symptoms and prognosis if you stop smoking, develop healthy eating habits, avoid lung irritants, and get more physical activity right away. Building these skills early on is key for maintaining a good quality of life with COPD.


Stage 2: Moderate COPD

At stage 2 of the disease, COPD symptoms become more pronounced and new symptoms may appear. This is the stage that many people start to notice their breathing difficulties and decide to seek help from a doctor.


At this point, lung function has declined further than stage 1, and the signs of COPD are more obvious. At this point, patients might be prescribed longer-lasting medications to deal with chronic symptoms and might be referred to a COPD support program to better learn how to manage their disease.


Red smoke arranged in the shape of human lungs.


Stage 2 COPD Symptoms

With stage 2 COPD, you will notice symptoms that are more noticeable and more persistent than they were at stage 1. You might also notice some new symptoms, like chronic breathlessness or difficulty coughing up mucous.


Here are the symptoms characteristic of Stage 2 COPD:

  • Worsening airflow restriction
  • Worsening breathlessness, especially after heavy activity
  • Increased mucous and phlegm in airways
  • Persistent, chronic coughing
  • Difficulty expelling phlegm from lungs
  • FEV1 Value of 50-79% of normal


Whereas you might have been able to brush off your symptoms at stage 1, at stage 2 they often become too obvious to ignore. It's important to seek treatment from a medical professional knowledgeable about COPD in order to properly manage your symptoms.


Treatment Options

At stage 2, you will have all of the treatment options that were available at stage 1 plus more. You are likely to need some kind of medication to help with your symptoms.


Even if you are already using short-acting bronchodilators, your doctor might prescribe you a more long-term medication to help with chronic symptoms.


If you are having difficulty exercising and managing your symptoms, your doctor might also refer you to pulmonary rehab to help you get a jump-start on healthier habits.


Pulmonary Rehabilitation

Many doctors suggest pulmonary rehabilitation to patients who have difficulty managing their symptoms and changing their diet and exercise routines.


However, pulmonary rehab programs are a good idea for anyone diagnosed with COPD, as they encompass a variety of educational, psychological, and physical activity programs to help people with respiratory conditions.


Woman with nasal cannula undergoing pulmonary rehabilitation.


Pulmonary rehabilitation programs are like a COPD boot camp, and attending one is a great way to kick-start your treatment. They are run by qualified therapists and health professionals who can help you learn and practice healthy habits.


Pulmonary Rehab: Education

It's important to know as much as you can about your disease so you can take an active role in managing it. Pulmonary rehabilitation programs put a strong focus on helping people understand COPD and respiratory health so they can make more informed and healthy decisions.


Unlike a regular health lecture, lessons from pulmonary rehab are tailored to be practical and relevant to YOU. After all, it would be tragic if your symptoms worsened or your disease progressed because you didn't have the information you need to understand and manage COPD.


A good pulmonary rehabilitation program will teach you everything you need to know about your disease and how to manage it, so you have everything you need to keep your COPD in check. What's more, you will also receive counseling on how to manage your disease emotionally and stay motivated to follow your treatment plan in the face of adversity.


Here are some topics that you can learn more about in pulmonary rehab:

  • How to cope with your illness
  • How to seek support from doctors, family, and friends
  • How to keep up and comply with your treatment plan
  • Exercises and techniques for better breathing
  • Physical activities that are particularly helpful for people with COPD
  • Techniques for how, when, and how often to use your inhaler


Once you complete a pulmonary rehabilitation program, the knowledge you've gained will give you a solid foundation for living with COPD.


Pulmonary Rehab: Diet and Exercise

Maintaining a healthy diet and getting enough physical activity is the most important part of managing COPD. That's one thing that pulmonary rehabilitation programs are good for—helping you to understand what proper nutrition and exercise looks like when you have COPD.


It will help you understand not only what kind of exercises to do and how often to do them, but also the reasons and theory behind why they will help you. It's much easier to stay motivated and stick with a healthy routine when you understand why it's beneficial, instead of just doing it because someone told you to.


Dumbbell, three apples, and a chalk board with the words "diet & exercise" written on it.


Here are some things you can learn about diet and exercise in pulmonary rehab:

  • What regular activity and exercise should look likelihood
  • Why regular exercise is important, and how it will help your COPD
  • Breathing techniques to make physical activity easier
  • Foods and drinks that can worsen COPD symptoms
  • Tips for planning and preparing healthy meals
  • And much more!


Pulmonary Rehab: Support Groups

One thing you can't underestimate when you have a chronic illness is the power of a support system. Having people around you to help and support you as you manage your COPD can help you stay motivated and hopeful.


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