Stage III (Severe Stage) COPD

Medically Reviewed by Dany Paul Baby, MD on April 06, 2023
5 min read

As chronic obstructive pulmonary disease (COPD) reaches stage III, it starts to have a bigger impact on the way you live your life. The condition may sap your strength and make it hard to work or do chores. But treatment and lifestyle changes can help you manage the challenges and stay active.

If you're in stage III of COPD, you typically get problems like:

  • Flare-ups more often
  • More serious shortness of breath (trouble doing basic chores)
  • Getting tired more easily 
  • Worse coughing and more mucus

You may also have:

  • More colds 
  • Swelling in your ankles, feet, and legs
  • Tightness in your chest
  • Trouble taking a deep breath
  • Lung infections
  • Wheezing, rapid breathing, and other breathing issues when doing basic tasks
  • Signs of scarring, holes, or enlargement in your lungs on X-rays and other imaging scans

Get medical help right away if you notice any of these symptoms:

  • Faster heartbeat than normal
  • Hard time catching your breath or talking
  • Lips or fingernails turn blue or gray
  • You seem out of it or not very alert (Your loved ones can keep an eye out for this.)


A spirometry test, just like the ones you had when you were first diagnosed with COPD, will tell you if your condition is changing. If it shows your forced expiratory volume (FEV1) is between 30% and 49%, you're in stage III.

You may get other tests to help guide your treatment. For example, checking the oxygen level in your blood might show that oxygen therapy could help you.

Other tests might include:

  • Computed tomography scan
  • Chest X-ray
  • Routine laboratory tests
  • A walking test where doctors track your breathing, blood pressure, pulse, and oxygen level

As with stage II, you'll keep using drugs called 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.

You'll still have a pulmonary rehab plan that gives you tailored advice on exercise and other lifestyle issues. You may need to use steroids and antibiotics more often to manage flare-ups.

To help you breathe better, you may start oxygen therapy. You breathe in oxygen, through either a mask or small tubes that sit just inside your nose. You might start out using it only at certain times, but it usually ramps up from there.

Other treatments 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. Doctors also may suggest a minimally invasive procedure called "endoscopic lung volume reduction." 

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.

Weight loss can become an issue during stage III. That's because when you're tired and short of breath, you may lose your desire to eat.

That can set up a tough cycle. When you don't get the nutrients you need, your symptoms can get worse. And, you're more likely to get illnesses like a cold or the flu. All of that might mean you feel like eating even less.

As physical activity gets harder to do, your overall physical and mental health can take a hit as well. And, COPD can lead to conditions like anemia, heart failure, and osteoporosis.

As with earlier stages, quitting smoking still makes a big difference.

It also helps to:

Be ready for an emergency. In case you have a serious flare-up, it's good to have your phone and medicines handy. Make sure you have phone numbers for your doctor or hospital. And keep an updated list of medicines you take so you can give it to any doctor who treats you.

Keep your weight up. If you're losing weight, make sure to let your doctor and dietitian know. It's typically best to:

  • Avoid sugar and go with foods high in protein and fat, like whole-milk cheese.
  • Choose high-fiber foods, like fruits, veggies, beans, and whole grains.
  • Eat 5-6 smaller meals instead of three big ones.
  • Stick with foods that are easier to chew.

It can also help to:

  • Chew slowly and take your time between bites.
  • Keep food within reach so you don't have to work to get it.
  • Save your drink until after you eat so you don't fill up on liquids.
  • Take a rest before you eat.

Stay active. Always check with your doctor to see what's safe for you. If you use oxygen, you'll need it when you exercise, too.

You might think you're too sick or too out of breath to do anything, but you can start slowly and build up. There's no need to push yourself. You just want a moderate workout.

You can push through feeling tired or shaky, but you want to stop or avoid exercising if you have:

Stay safe with oxygen therapy. Fire is a serious risk when you have oxygen around. Keep these things in mind:

  • Never put oil anywhere on the oxygen unit or handle it with greasy hands.
  • Avoid lotions like vapor rubs and creams with petroleum jelly. Stick with water-based ones instead.
  • Be careful near heat sources, like stoves and heaters.
  • Don't smoke while taking oxygen or anywhere near the tank.
  • Stay away from open flames, such as matches and candles.

Get a flu vaccination. Doctors recommend you get the annual flu vaccine if you have COPD because the flu can greatly worsen COPD symptoms. The vaccine can prevent you from getting it or lessen its effects if you do.