Understanding and Treating COPD
The more you know, the easier it is to control COPD.
Stages of COPD and Lung Function
The stages of COPD are based on the severity of lung function, measured as airway obstruction.
To determine the severity of lung function, doctors use a test called spirometry. You blow into a mouthpiece and tubing that’s attached to a recording device. The test measures your ability to move air in and out of the lungs quickly.
One specific measurement, FEV1, or forced expiratory volume, shows how much air a person can blow out in one second. FEV1 is used to determine how far COPD has progressed. There are four stages of COPD:
• Stage 1: Mild. FEV1 is greater than 80%. At this stage, the person with COPD may not even be aware that there is any abnormal lung function.
• Stage 2: Moderate. FEV1 is between 79% and 50%. At this stage, the person may have shortness of breath and other respiratory symptoms.
• Stage 3: Severe. FEV1 is between 49% and 30%. At this stage, the person may have a reduced ability to exercise. The person may also have more shortness of breath and frequent exacerbations.
• Stage 4: Very Severe. FEV1 is below 30%. At this stage, the person may have life-threatening exacerbations. Some patients have chronic respiratory failure.
COPD Treatments Can Vary
No matter your stage, the goal of COPD treatment is to:
• relieve symptoms
• improve health and exercise tolerance
• prevent complications and worsening of illness
But people with COPD may need very different treatments based on the severity of their condition, says Richard ZuWallack, MD. ZuWallack is the associate chief of pulmonary and critical care medicine at Saint Francis Hospital and Medical Center in Hartford, Conn.
“One person with COPD may be asymptomatic and might just need a smoking cessation program,” ZuWallack says. “Then another person with COPD could have more moderate symptoms and need rehabilitation and psychopharmacology.”
Guidelines for treating COPD are set out in the Global Initiative for Chronic Obstructive Lung Disorder (GOLD).
COPD treatment includes:
Smoking cessation. Stopping smoking can help slow the decline in lung function as measured by FEV1.
Oxygen therapy. When the lungs cannot function well, inhaled oxygen helps get enough oxygen into the blood to meet the body’s needs.
Nutrition. People with COPD often lose weight, which can lead to loss of muscle mass. Underweight people with COPD often have greater difficulty breathing.
Bronchodilators. These medications relieve symptoms, improve exercise capacity, and improve airway obstruction. They work by opening up the air passages and making it easier to breathe. There are many different kinds of bronchodilators. Atrovent, for example, is short acting, so it’s used for the immediate relief of symptoms. Spriva, by contrast, is long acting, so it’s used to help keep airways open day to day.
Corticosteroids. These drugs, such as prednisone or budesonide, are used to reduce inflammation and to treat symptoms, especially symptoms of an exacerbation. These medications may help slow the progression of the lung symptoms.
Vaccines. COPD can flare up and worsen when you get sick, so it’s important to get the flu shot and the pneumonia shot.
Surgery. Several surgeries, including lung transplantation, can reduce symptoms and improve a person’s quality of life when medications are not effective.
Antibiotics. Antibiotics treat bacterial infections and are used primarily during an exacerbation.
Oxygen therapy has clearly been shown to prolong life, says Schachter. Patients with COPD should not rely solely on a test at the doctor’s office to see if they need oxygen therapy. Be sure to monitor levels at home, especially at night.
“Doctors can check oxygen levels at the office. But because oxygen levels drop during sleep at night, there are home monitors that can record oxygen saturation. This helps doctors see if patients may qualify for oxygen therapies,” Schachter says.