Stage II (Moderate Stage) COPD

Medically Reviewed by Dany Paul Baby, MD on April 10, 2023
5 min read

As chronic obstructive pulmonary disease (COPD) gets worse, it limits your airflow more and more. By stage II, your symptoms are usually no longer something you can just shrug off. They start to affect your daily life.

Since it's sometimes easy to miss the early signs of COPD, this is the stage where a lot of people go to the doctor to find out what's going on -- and may first learn they actually have the disease.

Anything you had in the first stage often gets worse in stage II. Not everyone gets the same symptoms, but you may have:

  • Constant coughing, along with mucus, that's often worse in the morning
  • Shortness of breath that makes even household chores a challenge
  • Tiredness
  • Trouble sleeping
  • Wheezing when you exercise or during a flare-up

It can start to affect your mental health, too. You may get forgetful, confused, or have slurred speech.

The most common symptom of COPD is breathlessness, but it isn't the only one. You may also have flare-ups, called exacerbations. This is when your symptoms get worse and may require treatment. About 20% of stage II patients have frequent exacerbations requiring antibiotics or steroids. In addition to worsening shortness of breath, keep an eye out for:

  • Feeling confused
  • Change in color of mucus, which may be the first sign of a flare-up
  • Change in amount of mucus, either more or less
  • More coughing
  • More tiredness
  • New sleep problems
  • Symptoms bad enough to require a hospital visit
  • Lung infections
  • Signs of scarring, holes, or enlargement in your lungs on X-rays and other images

Tell your doctor if you have any of these. Get medical help right away if you feel confused or have trouble breathing.

As with stage I, you'll talk to your doctor about your health history and get a physical exam. You'll also take a simple breathing test (spirometry test). One of the results from it, known as "forced expiratory volume in one second" (FEV1), tells you the stage you're in. 

You have stage II if FEV1 is from 50% to 80%. Your doctor may also test your lungs in other ways such as:

  • 6-minute walk test: Measures vital signs after walking.
  • Peak expiratory flow (PEF): Measures how fast you can blow out air (sometimes part of spirometry test).
  • Fractional exhaled nitric oxide (FeNO): Measures levels of exhaled nitric oxide (high levels could mean inflamed lungs).
  • Arterial blood gas: Measures oxygen and carbon dioxide levels in blood.

From there, you may get blood tests, exercise tests, imaging, and more. They'll reveal important details about how COPD is affecting your body and how your lungs are working. That can help you and your doctor figure out the best treatment.

If you have a family history of COPD or develop COPD at a young age, your doctor may suggest a test for a genetic disorder -- alpha-1-antitrypsin deficiency -- which may be a cause of COPD in some people.

There is no cure for COPD, but you can manage the symptoms. This can be complex, so you'll need to work closely with your doctor. The goal is to relieve your symptoms, keep your lungs working as well as possible, and prevent flare-ups.

For stage II, the main treatments are:

Quitting smoking and avoiding secondhand smoke.

Medicine. Typically, you get drugs called bronchodilators, which make breathing easier. 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. There are two general types:

  • Short-acting ones last 4-6 hours. You take them when you need relief from symptoms.
  • Long-acting ones last 12 or more hours. You take them every day to help keep things in check. You may get more than one of these.

Pulmonary rehab. This is a program aimed at helping you keep up your quality of life. You may work with doctors, nurses, physical therapists, and others to create a plan tailored to your needs.

Your plan might include things like:

  • Counseling to help with the challenges of having a long-term health condition
  • An exercise routine that's safe for you
  • Tips on how to eat a healthy diet
  • Training on ways to best manage COPD

It's important to take an active role in your treatment. When you keep on top of your meds, appointments, and other parts of your program, you lower your odds of having a flare-up or needing to go to the hospital.

Managing flare-ups. Like the disease itself, flare-ups may range from mild to severe. Your doctor will help you come up with a plan for how to handle them.

For a mild flare-up, you may need to take bigger doses of your regular meds. For more serious ones, you may need:

  • More medicine, such as steroids and antibiotics
  • Oxygen, since it usually drops during a flare-up (doctor must manage oxygen use for safe use)
  • Treatment in the hospital

It's best to deal with flare-ups right away. If you're not sure what to do, call your doctor as soon as possible.

To help prevent them, quit smoking, and get the vaccinations that we have to protect you from lung infections. These include the flu vaccine, pneumonia vaccine, and COVID-19 vaccine. 

Other treatments may include: 

Surgery: In serious cases, your doctor might suggest lung volume reduction surgery to remove or block off a diseased part of your lung. The purpose is to help 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 organs. Transplants are for people who likely will die without it.

Flare-ups can land you in the hospital, and they can be life-threatening. They can cause your oxygen levels to fall sharply, make it very hard to catch your breath, and throw off your heart rhythm.

COPD also raises your odds of having heart disease, lung cancer, and high blood pressure in your lungs (in severe COPD). Check with your doctor to see how you can limit your risks for these other conditions.

Make sure you tend to your overall well-being and keep an eye on your mood, since people with COPDcan sometimes get depressed. If you find that you're often sad or feel helpless or hopeless, talk to your doctor.