Table of ContentsView AllTable of ContentsSymptomsDiagnosisLife ExpectancyTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Diagnosis
Life Expectancy
Treatment
Coping
End-stagechronic obstructive pulmonary disease(COPD) refers to being in the final stages of the disease. At this stage, you can expect to experience significant shortness of breath even when resting. Because of the degree of lung damage at this stage, you are at high risk for lung infections andrespiratory failure.
You might associate the term “end-stage” with imminent death or grave disability that’s leading up to death. Certainly, there is a higher risk of death at this stage, but you can survive for years with end-stage COPD.
This article defines end-stage COPD and explains how it is diagnosed. It presents treatment options commonly used in end-stage COPD and tips for coping with end-stage concerns.
With advanced COPD, you can have symptoms all the time or almost all the time. And the effects of your disease at the end-stage will be so advanced that they will undeniably affect your day-to-day activities.
Symptoms you can experience with end-stage COPD include:
Emphysema vs. COPD: Similarities and Differences
How Is End-Stage COPD Diagnosed?
By definition, “end-stage” refers to the last phase in the course of a progressive disease. There are criteria that help define this stage.
According to the Global Initiative for Obstructive Lung Disease (GOLD), there are fourstages of COPD:
Each stage is defined according to thespirometry measurementofFEV1(the volume of air breathed out in the first second after a forced exhalation). End-stage COPD is considered stage IV, or very severe COPD with an FEV1 of less than or equal to 30%.
Other Tests to Measure COPD StagesThe Global Initiative for Obstructive Lung Disease (GOLD) defines four stages of COPD, with Stage IV as its end stage. It was updated in 2017. Other systems to evaluate COPD include:ADO scores, which measure age, dyspnea (shortness of breath), and obstructionDOSE scores, used to measure dyspnea, obstruction, smoking, and exacerbationBODE assessment forbody mass index(BMI), obstruction, dyspnea, and exerciseSpirometry, often used to measure lung functionA 12-year study of 490 people in Sweden, published in 2021, looked at these methods and found the ADO and the lung function assessments were most accurate in predicting life expectancy and mortality.
Other Tests to Measure COPD Stages
The Global Initiative for Obstructive Lung Disease (GOLD) defines four stages of COPD, with Stage IV as its end stage. It was updated in 2017. Other systems to evaluate COPD include:ADO scores, which measure age, dyspnea (shortness of breath), and obstructionDOSE scores, used to measure dyspnea, obstruction, smoking, and exacerbationBODE assessment forbody mass index(BMI), obstruction, dyspnea, and exerciseSpirometry, often used to measure lung functionA 12-year study of 490 people in Sweden, published in 2021, looked at these methods and found the ADO and the lung function assessments were most accurate in predicting life expectancy and mortality.
The Global Initiative for Obstructive Lung Disease (GOLD) defines four stages of COPD, with Stage IV as its end stage. It was updated in 2017. Other systems to evaluate COPD include:
A 12-year study of 490 people in Sweden, published in 2021, looked at these methods and found the ADO and the lung function assessments were most accurate in predicting life expectancy and mortality.
How Long Can You Live With End-Stage COPD?
Research suggests that people diagnosed with COPD lose an average of six years in life expectancy when compared with their counterparts who don’t have COPD. But other conditions, such as heart disease, actually accounted for two-thirds of these deaths.
The individual prognosis for someone with end-stage COPD will depend on a number offactors that influence COPD life expectancy. They include:
Some people in end-stage COPD are still able to function reasonably well with few limitations. On the other hand, there are also many people at this stage who are very sick. You also can develop complications of lung disease that include:
With end-stage COPD, you are likely to have limitations in your activity levels, which leads to a risk ofblood clots, obesity, andpressure sores.
Often, treatment options haven’t been exhausted when diagnosed with end-stage COPD. There may be aspects of your health that can be managed to help make you feel more comfortable and to avoid complications of your pulmonary condition.
For example, you are likely to have lowoxygen saturationlevels (needed oxygen in your blood) and you will probably be prescribed supplemental oxygen. If you take a break from your oxygen supplementation, you may notice your symptoms worsening.
As the severity of your disease advances, the focus of your treatment may begin to shift topalliative careto relieve yourCOPD symptoms.
If you’re facing a diagnosis of end-stage COPD, your healthcare provider may prescribe the following treatments:
Pulmonary Rehabilitation
Pulmonary rehabilitationhas been found to be beneficial for people with COPD at all stages of the disease. A 2017 study found that for people with severe COPD, pulmonary rehabilitation improved symptoms for 92% of the participants and resulted in 54% fewer days of hospitalization.
Nutritional Counseling
Nutrition counseling can help withmalnutrition, a common complication in end-stage COPD that increases the risk of death. A counselor who specializes in caring for people with COPD can also help with tips that make eating easier and more enjoyable amidst shortness of breath.
Bronchodilators
American Thoracic Society guidelines recommend that people with moderate or severe COPD who experience shortness of breath and/or exercise intolerance receive a combination of two different types of long-actingbronchodilatorsrather than a single long-acting bronchodilator alone.
This includes a long-acting beta-agonist (LABA) medication as well as a long-actinganticholinergic/muscarinic antagonist(LAMA). Some combination inhalers include both of these categories of medication in a single inhaler. Short-acting bronchodilators may also be used for symptoms.
Don’t Combine These COPD Medicines
Glucocorticoids
Glucocorticoids(steroids) may be used either via inhalation, or in an oral or intravenous form, and guidelines for their use have recently changed.
Oral glucocorticoids(such asprednisone) were once widely prescribed but should, in general, be avoided on a continual basis. (They may still be needed for exacerbations or during hospitalizations.) These medications were not found to affect shortness of breath, the risk of exacerbations, or survival, but did lead to a number of side effects such as high blood pressure and infection.
Inhaled glucocorticoidsmay or may not be recommended. While they reduce the risk of exacerbations, they also increase the risk a person will develop pneumonia. They are likely helpful for people who also haveasthmaor who have one or more COPD exacerbations each year.
An Overview of COPD Exacerbations
Supplemental Oxygen
Opiates
In the past, opiates were often avoided as some studies showed they may have serious side effects and may not benefit everyone.The latest guidelines, however, encouragethe use of opiate medications for people who continue to have significant shortness of breath despite maximizing other therapies.
This recommendation came about due to studies showing these medications were beneficial in improving quality of life, while not leading to an increased risk of falls/accidents or overdoses.
Noninvasive Positive Pressure Ventilation (NIPPV)
Noninvasive ventilation may lessencarbon dioxide retentionand improve shortness of breath, but it’s not routinely recommended.
Surgery
Various surgical procedures may be needed in treating end-stage COPD in some people. These procedures can include:
Lung transplant, in eligible candidates with severe COPD, also may be a surgical treatment option.
Complementary TherapiesComplementary and alternative therapy such as relaxation and visualization techniques, therapeutic massage, and music therapy with live instruments or recorded music can help soothe symptoms like shortness of breath.
Complementary Therapies
Complementary and alternative therapy such as relaxation and visualization techniques, therapeutic massage, and music therapy with live instruments or recorded music can help soothe symptoms like shortness of breath.
Living with end-stage COPD can make you feel scared and isolated. Getting psychological andsocial supportis an important aspect of coping with the condition.
Lifestyle Changes
Even when you have already developed very advanced COPD, there are several lifestyle changes that you can incorporate to have the best outcome possible:
End-of-Life Issues
If your healthcare providers have discussed the chance that death is approaching due to your COPD, it’s time to consider how you will manage end-of-life issues.
Whether you or aloved oneis taking charge of the decisions at this point, deciding how you will seek help during the end-of-life stage can make the process a bit easier for everyone involved. For example, you and your family may want to consider enlisting the help of hospice to guide you through this time.
When you have been diagnosed with late-stage COPD, talk to your healthcare team and loved ones about your values and beliefs to help ensure that any end-of-life care is consistent with your wishes. For resources to help with planning end-of-life care, visit theNational Healthcare Decisions Day website.
Advanced directives are documents that allow you to explain your wishes regarding end-of-life care. Your loved ones will then know what you want in terms of issues like resuscitation, feeding tubes, and ventilator support if you are unable to express your wishes at a later time.
Symptom management is one of the most important aspects of end-of-life care because COPD symptoms often worsen in the final days—most notably, dyspnea andcough, pain,anxiety and depression, confusion, anorexia, and muscle wasting known ascachexia.
The end of life is a time of sadness and deep reflection for you and your loved ones. Remember that simple gestures like holding your loved one’s hand and being present can provide immense comfort.
Summary
While COPD is a progressive disease, there are a number of treatments available to keep you as healthy as possible for as long as possible. Lifestyle changes, including exercise and smoking cessation, also will help as you work with your care team to develop a treatment plan.
On average, a person with COPD will lose six years of life expectancy but may have many years yet to live. Your prognosis will depend on many factors and there is no way to predict exactly how long you will live. Be sure to make decisions about your health and treatment options with your providers to ensure your best quality of life.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Arjuna A, Olson MT, Walia R.Current trends in candidate selection, contraindications, and indications for lung transplantation.J Thorac Dis. 2021 Nov;13(11):6514-6527. doi:10.21037/jtd-2021-09.
Maddocks M, Lovell N, Booth S, Man WD, Higginson IJ.Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease.Lancet. 2017;390(10098):988-1002.doi:10.1016/S0140-6736(17)32127-X
Bernabeu-Mora R, Sánchez-Martínez MP, Montilla-Herrador J, Oliveira-Sousa SL, Gacto-Sánchez M, Medina-Mirapeix F.2011 GOLD Stages of COPD: Transitions, Predictor Factors and Comparison with 2017 GOLD Stages.Int J Chron Obstruct Pulmon Dis.2020 Jun 30;15:1519-1527. doi:10.2147/COPD.S254434.
Global Initiative for Chronic Obstructive Lung Disease.Pocket guide to COPD diagnosis, management, and prevention. A guide for professionals.
Shu CC, Lee JH, Tsai MK, Su TC, Wen CP.The ability of physical activity in reducing mortality risks and cardiovascular loading and in extending life expectancy in patients with COPD.Sci Rep. 2021 Nov 4;11(1):21674. doi:10.1038/s41598-021-00728-2.
Nici L, Mammen MJ, Charbek E, et al.Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline.American Journal of Respiratory and Critical Care Medicine. 201(9). doi:10.1164/rccm.202003-o625ST
Smallwood N, Currow D, Booth S, Spathis A, Irving L, Philip J.Differing Approaches to Managing the Chronic Breathlessness Syndrome in Advanced COPD: A Multi-National Survey of Specialists.COPD. 2018;15(3):294-302.doi:10.1080/15412555.2018.1502264
Buttery SC, Banya W, Bilancia R, Boyd E, Buckley J, Greening NJ,et al.Lung volume reduction surgeryversusendobronchial valves: a randomised controlled trial.Eur Respir J. 2023 Apr 27;61(4):2202063. doi:10.1183/13993003.02063-2022.
Welling JBA, Hartman JE, Augustijn SWS, Kerstjens HAM, Vanfleteren LEGW, Klooster K,et al.Patient Selection for Bronchoscopic Lung Volume Reduction.Int J Chron Obstruct Pulmon Dis. 2020 Apr 23;15:871-881. doi:10.2147/COPD.S240848.
Leard LE, Holm AM, Valapour M, Glanville AR, Attawar S, Aversa M,et al.Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation.J Heart Lung Transplant. 2021 Nov;40(11):1349-1379. doi:10.1016/j.healun.2021.07.005.
Roos AB, Sandén C, Mori M, Bjermer L, Stampfli MR, Erjefält JS.IL-17A Is elevated in end-stage chronic obstructive pulmonary disease and contributes to cigarette smoke-induced lymphoid neogenesis.Am J Respir Crit Care Med. 2015;191(11):1232-41.doi.10.1164/rccm.201410-1861OC
Tavares N, Jarrett N, Hunt K, Wilkinson T.Palliative and end-of-life care conversations in COPD: a systematic literature review.ERJ Open Research. 2017 Apr 1;3(2):00068-2016.doi:10.1183/23120541.00068-2016
Tselebis A, Pachi A, Ilias I, et al.Strategies to improve anxiety and depression in patients with COPD: a mental health perspective.Neuropsychiatr Dis Treat. 2016;12:297–328. doi:10.2147/NDT.S79354
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
