If you have chronic obstructive pulmonary disease (COPD), your symptoms may worsen over time. Your treatments may change along with them.
Doctors divide COPD into four stages, depending on how severe your condition is. Treatment in any stage is tailored to relieve your symptoms, slow how fast your COPD is getting worse, and lower your risk of lung cancer and other problems.
Stage 1 (mild COPD)
This is when you might have slight trouble breathing and sometimes cough up mucus. If your COPD is mild, you may not even realize that you have it. But your lungs may already be damaged.
First, if you smoke, your doctor will ask you to quit and stay away from secondhand smoke. They also most likely will recommend:
- Vaccinations. Getting the flu, COVID-19, pneumonia, and other infections can make your COPD worse. Ask your doctor which vaccines you need and how often.
- Short-acting bronchodilators. These medications open up your airways by relaxing the muscles that surround them. They can help if you have symptoms now and then. If your symptoms are more persistent, you may need to use short-acting bronchodilators regularly. These include albuterol (AccuNeb, Proventil, Ventolin), albuterol sulfate (ProAir HFA, ProAir RespiClick), and levalbuterol (Xopenex).
Stage 2 (moderate COPD)
In this stage, you may feel short of breath more often, usually after exercise. You’ll also notice that your airflow is worse overall. Your doctor may add treatments or adjust your current therapy:
- Long-acting bronchodilators. These work longer than a short-acting bronchodilator (rescue inhaler). For stage 2, you may need to use both a long- and short-acting bronchodilator. The most common long-acting bronchodilators are formoterol, salmeterol (Serevent), and tiotropium (Spiriva). Some medications include a combination of different bronchodilators.
- Pulmonary rehabilitation. This form of rehab will help build your fitness and improve your breathing with COPD. You’ll learn more about your condition, do exercises with an instructor, and practice breathing techniques.
Stage 3 (severe COPD)
By this point, your condition may have a big effect on your life. You may have flares often and tire easily. Your coughing is worse, and you have more mucus. You will still use bronchodilators. Your treatments for severe COPD also may include:
- Inhaled corticosteroids. These strong drugs help lower the swelling in your airways and help prevent flare-ups. Corticosteroids also may help your other treatments work better. The most common inhaled corticosteroids for COPD include beclomethasone dipropionate (Qvar), budesonide (Pulmicor), and fluticasone propionate (Armonair, Arnuity, Flovent). Your doctor can also prescribe combination medications that include a corticosteroid and one or more bronchodilators.
- Oxygen therapy. You breathe in oxygen through a mask or small tubes that go just inside your nose. This can help you when you have trouble breathing.
Stage 4 (very severe COPD)
This is sometimes called end-stage COPD. You will still use all the same treatments you’ve used before. But at this point, your lungs may be severely damaged and limit the amount of air you can breathe in and out. You may have frequent flare-ups, which may be deadly. For stage 4, your doctor may continue with your current treatments, combine different drugs, raise the dosages, or use them more often.
- Oxygen therapy. You may need this long-term so you can breathe better. You can get oxygen therapy at a hospital or in your own home. Relying on oxygen therapy for more than 15 hours a day can help you live longer than going without.
- Lung surgery. This may be an option if you’re strong enough, don’t smoke, and agree to a pulmonary rehab program after the surgery. The two main types of lung surgery are:
- Bullectomy. Your surgeon takes out one or more air sacs from your lungs. These sacs can become enlarged to a point where they block your airflow.
- Lung volume reduction surgery (LVRS). This removes the most diseased parts of your lung tissue so that the healthy areas work better. LVRS also may improve other parts of your body, such as your diaphragm.
If your lungs are too damaged for repair, your doctor may suggest an organ transplant. This surgery carries serious risks and is considered only if nothing else has helped. You’ll need to take immune-suppressing medications for life.
Palliative Care
This is a type of medical care that focuses on your quality of life and helps you manage common issues like stress and worry. Palliative care may help you at any stage of COPD. Your palliative care team can give you medication to ease shortness of breath, anxiety, or depression. They also can tell you if yoga, talk therapy, and relaxation programs may help you.