Palliative care

Palliative care or hospice care can greatly enhance your life when you’re living with end-stage COPD. A common misconception about palliative care is that it’s for someone who will be passing away soon. This isn’t always the case.

Instead, palliative care involves identifying treatments that can enhance your quality of life and help caregivers provide you with more effective care. The main goal of palliative and hospice care is to ease your pain and control your symptoms as much as possible.

You’ll work with a team of doctors and nurses in planning your treatment goals and caring for your physical and emotional health as much as possible.

Ask your doctor and insurance company for information about palliative care options.

Stages (or grades) of COPD

COPD has four stages, and your airflow becomes more limited with each passing stage.

Various organizations may define each stage differently. However, most of their classifications are based in part on a lung function test known as the FEV1 test. This is the forced expiratory volume of air from your lungs in one second.

The result of this test is expressed as a percentage and measures how much air you can let out during the first second of a forced breath. It’s compared to what is expected from healthy lungs of similar age.

According to the Lung Institute, the criteria for each COPD grade (stage) are as follows:

Grade Name FEV1 (%)
1 mild COPD ≥ 80
2 moderate COPD 50 to 79
3 severe COPD 30 to 49
4 very severe COPD or end-stage COPD < 30

The lower grades may or may not be accompanied by chronic symptoms, such as excess sputum, noticeable shortness of breath with exertion, and chronic cough. These symptoms tend to be more prevalent as COPD severity increases.

In addition, new Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines further categorize people with COPD into groups labeled A, B, C, or D.

The groups are defined by the seriousness of problems such as dyspnea, fatigue, and interference with daily living, as well as acute exacerbations.

Exacerbations are periods when symptoms get noticeably worse. Exacerbation symptoms can include a worsening cough, increased yellow or green mucus production, more wheezing, and lower oxygen levels in the bloodstream.

Groups A and B include people who’ve had no exacerbations in the past year or only a minor one that didn’t require hospitalization. Minimal to mild dyspnea and other symptoms would put you in Group A, while more serious dyspnea and symptoms would place you in Group B.

Groups C and D indicate that you’ve either had at least one exacerbation that required hospital admission in the past year or at least two exacerbations that did or didn’t require hospitalization.

Milder breathing difficulty and symptoms put you in Group C, while having more breathing troubles means a Group D designation.

People with a stage 4, Group D label have the most serious outlook.

Treatments can’t reverse damage that’s already been done, but they can be used to try to slow down COPD’s progression.


In end-stage COPD, you’ll likely need supplemental oxygen to breathe, and you may not be able to complete activities of daily living without becoming very winded and tired. Sudden worsening of COPD at this stage can be life-threatening.

While determining the stage and grade of COPD will help your doctor choose the right treatments for you, these aren’t the only factors that affect your outlook. Your doctor will also take into account the following:


Although being overweight can make breathing more difficult if you have COPD, people with end-stage COPD are often underweight. This is partly because even the act of eating can cause you to become too winded.

Additionally, at this stage, your body uses up a lot of energy just to keep up with breathing. This can result in extreme weight loss that affects your overall health.

Shortness of breath with activity

This is the degree to which you get short of breath when walking or other physical activities. It can help determine the severity of your COPD.

Distance walked in six minutes

The farther you can walk in six minutes, the better outcome you will likely have with COPD.


With age, COPD will progress in severity, and the outlook tends to become poorer with passing years, especially in seniors.

Proximity to air pollution

Exposure to air pollution and secondhand tobacco smoke can further damage your lungs and airways.

Smoking can also affect outlook. According to a 2009 study Trusted Source that looked at 65-year-old Caucasian males, smoking reduced life expectancy for those with end-stage COPD by almost 6 years.

Frequency of doctor’s visits

Your prognosis is likely to be better if you adhere to your recommended medical therapy, follow through with all of your scheduled doctor’s visits, and keep your doctor up to date on any changes in your symptoms or condition. You should make monitoring your lung symptoms and function a top priority.

Coping with COPD

Dealing with COPD can be challenging enough without feeling lonely and scared about this disease. Even if your caregiver and the people closest to you are supportive and encouraging, you may still benefit from spending time with others who have COPD.

Hearing from someone going through the same situation may be helpful. They might be able to provide some valuable insight, such as feedback about various medications you’re using and what to expect.

Maintaining your quality of life is very important at this stage. There are lifestyle steps you can take, such as checking air quality and practicing breathing exercises. However, when your COPD has progressed in severity, you may benefit from additional palliative or hospice care.

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