Stage III (Severe Stage) COPD

Medically Reviewed by Jennifer Robinson, MD on August 28, 2022

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.

What Are the Symptoms?

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

  • Flare-ups more often
  • More shortness of breath
  • Tired more easily
  • Worse coughing and more mucus

You may also have:

  • Colds more often
  • Swelling in your ankles, feet, and legs
  • Tightness in your chest
  • Trouble taking a deep breath
  • Wheezing, rapid breathing, and other breathing issues when doing basic tasks

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
  • Seem out of it or not very alert (Your loved ones can keep an eye out for this.)

How Will My Doctor Test for Stage III?

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.

How Is It Treated?

As with stage II, you'll keep using drugs called bronchodilators, which help make breathing easier. 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.

What Other Problems Can Stage III Lead To?

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.

Living With COPD

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:

  • Avoid lotions 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.

Show Sources


Global Initiative for Chronic Obstructive Lung Disease: "What You Can Do About a Lung Disease Called COPD."

Oklahoma Department of Human Services: "Stages of COPD and Spirometric Classifications."

NIH, National Heart, Lung, and Blood Institute: "COPD."

Medscape: "Chronic Obstructive Pulmonary Disease (COPD)."

Johns Hopkins Medicine: "Signs of Respiratory Distress."

American Thoracic Society: "COPD Today," "Exacerbation of COPD." "Stages of COPD."

Cleveland Clinic: "Nutritional Guidelines for People with COPD."

COPD Foundation: "Exercise for Someone with COPD."

American Lung Association: "Supplemental Oxygen."

© 2022 WebMD, LLC. All rights reserved. View privacy policy and trust info