Stage 3 (Severe) Emphysema

Medically Reviewed by Paul Boyce, MD on November 05, 2019

If you have stage 3 emphysema, it means a large number of the 300 million tiny air sacs called alveoli that help bring oxygen into your body and get rid of carbon dioxide are damaged. As the alveoli break down, your bronchial tubes can start to collapse, too. That can trap air in your lungs and make your chest puff out, one of the telltale signs of advanced emphysema.

The disease is progressive, meaning that over time, it’ll get even harder for you to breathe. Some treatments may slow this process.

Stage 3 Emphysema

For emphysema, stages are a measure of how well you can breathe. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is one formula doctors use. GOLD divides emphysema into four stages, with 4 being the most severe. Your stage is one of many things that your doctor will weigh to evaluate how serious your emphysema is.

A machine called a spirometer measures your breathing for the GOLD standards. It measures two numbers:


Forced vital capacity (FVC): How much air you can breathe out after taking the biggest breath you can.

Forced expiratory volume-one second (FEV1): How much air you can breathe out in the first second after that big breath.

Your doctor uses those numbers to calculate how well you compare to your healthy peers.

You have emphysema if the ratio of FEV1 to FVC is less than 70%. That means that after you exhaled for 1 second, 30% or more of the air in your lungs hasn’t emptied out.

GOLD stage 3 emphysema is when the amount of air you can breathe out in 1 second falls between 30% and 49% of a healthy person.

How Serious Is Your Emphysema?

Stage 3 is also called severe emphysema. That means your disease is likely to be quite serious. As you get older, especially after age 65, breathing problems are more likely to interfere with basic daily tasks like dressing, cooking, or climbing stairs, and cause symptoms that send you to the hospital.


Once your doctor diagnoses your emphysema and establishes your GOLD stage, they’ll look at these other signs and symptoms to make a full assessment of your condition. They’ll want to know if you:

  • Have problems sleeping
  • Make high-pitched wheezing sounds when you breathe
  • Cough often, or cough up colored mucus
  • Have low blood oxygen levels
  • Have flare-ups when your breathing worsens
  • Have gone to the hospital for your emphysema symptoms
  • Get lung-related infections
  • Show signs of scarring, holes, or enlargement in your lungs on X-rays and other imaging scans


Lifestyle Treatment

Emphysema is one of three conditions that fall under the umbrella of chronic obstructive pulmonary disease (COPD). The other two are:

You can’t reverse your emphysema or COPD. But you can ease your symptoms and slow the progress of the disease. And the earlier you act, the better.

Quit smoking. It’s the No. 1 cause of emphysema and all COPD conditions. If you smoke, quitting is the single best step you can take.


Breathe smarter. You can learn to breathe with pulmonary rehabilitation therapy. You follow a set of breathing techniques and physical exercises to lessen breathlessness and boost your stamina. Your doctor or a specialized breathing therapist can help design a program for you.

Get to a healthy weight. In early emphysema, you may need to lose some pounds. But as your disease gets worse, you might find you need to put weight back on. Nutritional therapy from your doctor or a nutritionist can help you customize a diet based on your size, health, and activity level.

Medical Treatment

Emphysema is a condition that gets worse over time. But treatments can ease your symptoms or slow down your disease progress.

Bronchodilators: You inhale these medications to relax and to expand your airways. This allows more air into your lungs so your body gets more oxygen. Talk to your doctor about which type is right for you.

Oxygen: If your blood oxygen levels get low for too long, your doctor might suggest taking in extra oxygen from a machine through tubes that go into your nose. It’s most beneficial if you have severely low blood oxygen levels, not just moderately low. You and your doctor will typically reassess your oxygen needs every 2 to 3 months.


Surgery: In serious cases, your doctor might suggest surgery to remove a diseased part of your lung and stitch the rest back together. The purpose is to improve the stretchiness of your lungs and take pressure off the muscles that help you breathe. This treatment is not right for everyone, but it has shown some promise in certain types of patients with emphysema.

Transplant: If other treatments haven’t helped you, your doctor might recommend surgery to take out one or both of your lungs and replace them with donated lungs. Transplants are for people who likely will die without one.

WebMD Medical Reference



American Lung Association: “Nutrition and COPD.”

CDC: “Spirometry Reference Value Calculator.”

Cleveland Clinic: “Nutritional Guidelines for People with COPD,” “Emphysema.”

Global Initiative for Chronic Obstructive Lung Disease: “Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2019 Report.”

Harvard Health Publishing: “Emphysema.”

Mayo Clinic: “Emphysema,” “Spirometry.”

NIH: News in Health: “Oxygen Therapy for Patients with COPD.”

UpToDate: “Multidimensional assessment of COPD,” “Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging.”

Johns Hopkins University: “Emphysema.”

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