INFOGRAPHIC: Understanding the 4 Stages of COPD

By Michelle Cemental

Chronic obstructive pulmonary disease (COPD) is a group of progressive lung diseases that obstruct airflow. 65 million people have moderate or severe COPD and experts predict that this number will continue to increase.

However, there are ways to manage and slow the progression of your COPD. If you or a loved one need assistance with managing COPD, home care is an option.

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Understanding the 4 Stages of COPD


Stage 1 COPD is where you want to catch the disease to be diagnosed. However, due to the lack of symptoms, it often goes undiagnosed until a later stage.


  • Minor airflow limitations
  • Increase in mucus production
  • Possible chronic cough
  • Wheezing
  • Fatigue sets in faster and easier

Treatment Options for Stage 1 COPD

Short-Acting Bronchodilators

When you get prescribed a bronchodilator, there are a few different options your doctor may prescribe you:

  • Anticholinergics (ipratropium)
  • Beta2-agonists (albuterol or levalbuterol)
  • A combination of the two (a combination of albuterol and ipratropium)


The two most important vaccines for COPD are the:

  • FLU vaccine
  • Pneumonia vaccine

Both the flu and pneumonia can speed up the progression of your COPD. You will want to speak with your doctor about other vaccines that might benefit you.

Quit Smoking

Quitting smoking is hands down the best thing you can do for your COPD

Avoid COPD Triggers

Here is a list of known lung irritants you will want to avoid:

  • Pollution
  • Dust
  • Pollen (if you suffer from allergies)
  • Chemical based cleaning supplies
  • Perfume/ cologne
  • Smoke

Change Your Diet

A healthy COPD diet is going to consist of

  • Lean protein
  • Fruits
  • Vegetables
  • Whole grains
  • Hydrating liquids
  • Vitamin supplements

Some foods you want to avoid with COPD:

  • Fried and processed foods
  • Heavily spiced foods
  • Caffeinated and sugary drinks
  • Alcohol
  • Salty food
  • Nitrates
  • Sulfites
  • Food that causes heartburn, GERD, or acid reflux

Exercise and Stay Active

Here are a few different ways you can remain active:

  • Hiking
  • Gardening
  • Yoga
  • Golf
  • Kayaking
  • Playing an instrument
  • Bowling
  • Swimming

Stage 1 COPD overview

Your goal should be to make healthy lifestyle changes like quitting smoking, avoiding lung irritants, improving your diet, and exercising more.

Stage 2 COPD (Moderate)

Although some people still ignore the warning signs, stage 2 COPD is typically when most patients really start to notice their symptoms and seek medical help.

As other symptoms become more prevalent with COPD, chances are your lung function is also declining. According to GOLD guidelines, stage 2 COPD patients have an FEV1 of 50-79%.


  • Increased breathlessness, especially after exertion
  • Airflow limitations worsen
  • Cough severity worsens and becomes more persistent
  • Increased phlegm production
  • Phlegm is harder to expel

Treatments options for Stage 2 COPD

With stage 2 COPD, your new treatment options will be used in addition to your stage 1 COPD treatment options.

Long-Acting Bronchodilators

With stage 1 COPD, you get prescribed a short-acting bronchodilator to mange persistent symptoms. You will keep using your short-acting bronchodilator as needed; however, your doctor may prescribe one or more long-acting bronchodilators.

Pulmonary Rehabilitation

In short, pulmonary rehab is an extensive “training” program that teaches you how to cope with your respiratory disease, how to manage your symptoms, and how to implement new changes into your life that will help your overall health.

Antibiotics/ Corticosteroids (Inhaled or Oral)

Depending on your symptom severity and if you have an infection, your doctor may start to prescribe antibiotics to help treat and manage your COPD.

Also, stage 2 COPD is when you may start experiencing COPD exacerbations.

For the most part, you will be prescribed antibiotics when you are sick with bacterial infection. Especially if the infection can lead to a COPD exacerbation.

Stage 2 COPD Overview

Stage 2 COPD is the stage where most patients can no longer ignore the symptoms and seek medical help.

Treatment options have become more intense and are more about managing symptoms rather than preventative maintenance. Your treatment will include methods from stage 1 and stage 2.

Stage 3 COPD (Severe)

At stage 3 COPD, symptoms are far too debilitating to ignore any longer. Along with the common COPD symptoms, you may begin to experience more advanced symptoms that indicate your COPD is more severe. And according to GOLD guidelines, stage 3 COPD patients have an FEV1 of 30-49%.


  • Increased breathlessness
  • Increase in COPD exacerbations
  • Serious difficulty with any physical activity
  • Even more fatigue
  • Moring headaches
  • Edema (swelling around your feet or ankles)
  • Trouble with your weight (hard to maintain, lose, or gain weight)

Treatment options for Stage 3 COPD

Stage 3 COPD treatment become a little more intense than with previous stages. This is partly because your symptoms at a manageable level and to prevent loss of quality of life.

More Frequent Pulmonary Function Tests

Avoid Lung Irritants and Pollutants

Vaccinate and Avoid Large Crowds

As your COPD progresses, you may want to avoid large crowds, especially during cold and flu season.

This will minimize your risk of catching a cold, the flu, or pneumonia, and it will lower your risk of experiencing and exacerbation.

Supplemental Oxygen Therapy

As your COPD becomes more sever and your lung function deteriorates, there’s a good change you are going to require supplemental oxygen therapy.

Stage 3 COPD Overview

Stage 3 COPD is the stage where symptoms become more severe, difficult to manage, and more persistent.

Your treatment options have become more intense, and you have to closely monitor your symptoms. Your doctor may try switching treatment methods up to see if there’s a more effective way to manage your COPD.

You might experience more advanced symptoms like morning headaches and edema. Supplemental oxygen is more than likely being used at night possibly 24/7.

Your goals at stage 3 should be to slow the progression of your disease through a strict treatment regiment and healthy lifestyle changes.

Stage 4 COPD (Very Severe)


  • FEV1 below 30%
  • Significant airflow obstructions
  • Chest tightness
  • Pain near your chest or abdomen
  • Trouble maintaining a healthy weight
  • Heart problems from low O2 levels
  • Depression
  • Drowsiness
  • Confusion
  • Disorientation
  • More frequent exacerbations

It’s important to remember that everyone is different you might not experience the same symptoms as the next person. The main indicator for the different stages of COPD is your FEV1 test results.

Treatment options for Stage 4 COPD

Treating stage 4 COPD requires more effort and accountability. You really want to follow a strict treatment plan that includes:

  • A strict and healthy diet
  • A regular exercise plan
  • Taking your medications properly (at the right time and in the correct order)
  • Having a healthy support group
  • Pulmonary rehab (if possible)
  • A COPD action plan

Lung surgery

Lung Volume Reduction Surgery

A lung volume reduction surgery (LVRS) is exactly what it sounds like; your lung volume gets reduced.

LVRS is not a cure, but it can significantly improve your quality of life and make your COPD easier to manage.

Complete Lung Transplant

A complete lung transplant is usually a last resort. There are common complications that can make transplant very difficult; however, it can add years onto your life and reduce your symptoms.

Normally, the procedure is recommended when you might not live without it. Or it’s recommended when your disease is so severe you can no longer enjoy your life.

Stage 4 COPD Overview

Stage 4 COPD is the most severe stage. Your symptoms are extremely persistent, and they are difficult to manage. But the most difficult thing about stage 4 COPD is the stigma around it.

Do not let the fact that you have stage 4 COPD define your life. With proper treatment adherence and a strong support system, you will be able to live a high-quality life.


Regardless of which stage you are in, there are ways for you to slow the progression of your COPD. By following your treatment plan avoiding lung irritants and having a solid line of communication with your care team, you can live a high-quality life for years to come!

Tags: COPD, Senior Health