Understanding End-Stage COPD

Breathing is challenging as your lung function is minimal

Holding hands in a hospital bed
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Many people associate the term "end-stage" with imminent death or grave disability that's leading up to death. But as we explore the term further, you may be surprised to learn that this isn't always the case. 


By definition, "end-stage" refers to "the last phase in the course of a progressive disease." 

Some people think the term is carelessly applied to a patient when healthcare providers feel that they've done all they can do medically for a patient.

But there is generally always something healthcare providers can do for their patients with chronic obstructive pulmonary disease (COPD). In other words, it may just mean the goals of care have changed, from treating a disease to providing comfort.

Aside from the more subjective definition of end-stage COPD, where exactly does end-stage COPD fall in terms of COPD staging? In other words, what is the technical definition of end-stage COPD?

According to the Global Initiative for Obstructive Lung Disease (GOLD), there are four stages of COPD:

  • Stage I - Mild COPD
  • Stage II - Moderate COPD
  • Stage III - Severe COPD
  • Stage IV - Very Severe COPD

Each stage is defined according to spirometry measurement of FEV1 (the volume of air breathed out in the first second after a forced exhalation).

In terms of GOLD guidelines, end-stage COPD refers to being in the final stages of the disease, which is stage IV or Very Severe COPD.

This means that a person has significant shortness of breath even when resting and is at high risk for lung infections and respiratory failure.

But are the majority of people diagnosed with end-stage COPD gravely ill?

No, on the contrary; there are some people in stage IV who take excellent care of themselves.

They eat right, exercise religiously, and take their medications. They are still able to function relatively well with few limitations. On the other hand, there are also many people at this stage who are very sick.

Which group you fall into has to do with a number of factors that influence COPD life expectancy including your smoking history, your level of dyspnea (shortness of breath), fitness level, and nutritional status.


Although surgical intervention may be an option (for example, bullectomy, lung volume reduction surgery, or lung transplantation), it's likely to benefit only a small number of COPD patients.

For some, as the severity of their disease increases, the focus of treatment begins to shift away from prolonging life to providing palliative care to relieve COPD symptoms.

With that, if you're facing a diagnosis of end-stage COPD, your doctor may prescribe the following treatments:

  • Bronchodilators: Both short and long-acting bronchodilators are recommended if shortness of breath during regular activity is not relieved by short-acting bronchodilators alone.
  • Opiates: Morphine, in particular, may significantly improve shortness of breath. However, some studies show that it may have serious side effects and that it benefits only a select number of patients.
  • Inhaled glucocorticoidsThese may be prescribed for patients with a FEV1 less than 50 percent of predicted value and a history of repeated COPD exacerbations.
  • Supplemental oxygen: Oxygen reduces breathlessness caused by activity and improves exercise tolerance in patients with low blood oxygen levels.
  • Noninvasive Positive Pressure Ventilation (NIPPV): Noninvasive ventilation may lessen carbon dioxide retention and improve shortness of breath in some patients, but it's not routinely recommended.
  • Pulmonary rehabilitation: This has been proven to benefit COPD patients at all stages of the disease.
  • Nutritional counseling: This may be suggested because malnutrition is a common complication in end-stage COPD and increases the risk of death.
  • Psychological and social support: These are an important aspect of treatment because many patients do not discuss end-of-life issues with their doctors.
  • Complementary therapies: Relaxation and visualization techniques, therapeutic massage, and music therapy with live instruments, CD or radio can actually help soothe symptoms like shortness of breath.

End-of-Life Issues

If you believe the death of a loved one is approaching due to COPD, it's time to deal with managing their end of life issues. However, this can be incredibly difficult due to the debilitating nature of chronic obstructive pulmonary disease. 

To complicate matters, research has shown that in spite of COPD association with severe disability and premature death, COPD patients are still receiving inadequate end-of-life care.

For these reasons, you and your family may want to consider enlisting the help of hospice to guide you through this 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 and cough, pain, anxiety and depression, confusion, anorexia, and cachexia.

Overall, the end of a person's life can be a time of deep reflection for both patient and family. It can also be a time of great sadness. Remember though, that simple gestures like holding your loved one's hand and being present can provide immense comfort. 

Postponing End-Stage COPD

If the disease has not yet advanced, there are several lifestyle changes that a person can incorporate lifestyle to maintain optimal health. Here we'll discuss just a few:

Quit Smoking

Smoking cessation remains the single most important, cost-effective way to prevent and treat COPD. If your goal is to feel better, slow the progression of the disease and live longer, then you have no choice but to say goodbye to cigarettes once and for all.


Besides quitting smoking, if you are going to make one lifestyle change after a diagnosis of COPD that will have the greatest impact on your life, consider a daily exercise program.

Eat Healthy

Good nutrition should be the foundation from which to start your journey after a COPD diagnosis, or even if you've been diagnosed for years and want to make positive lifestyle changes to help you feel better. It's an essential part of any disease management program and gives those with COPD the vital energy they need to breathe and fight infection.

Stay Positive

Someone once said that life is 10 percent what happens to you and 90 percent what you do about it. Staying positive in the midst of a chronic illness diagnosis is difficult, but it's not impossible. It's all about developing some new coping mechanisms that will fit into your lifestyle.

A Word From Verywell

Understanding end-stage COPD and what you can do to prevent yourself from getting there starts with taking a long, hard look at yourself in the mirror and asking yourself one specific question: "Am I worth it?" The person who looks back at you will hopefully smile back and answer, "yes."


Ambrosino N, Gherardi M, Carpenè N. End-Stage Chronic Obstructive Pulmonary Disease. Pneumonol Alergol Pol. 2009;77(2):173-9. https://www.ncbi.nlm.nih.gov/pubmed/19462352.

Ambrosino N, Simonds A. The Clinical Management in Extremely Severe COPD. Respir Med. 2007 Aug;101(8):1613-24. https://www.ncbi.nlm.nih.gov/pubmed/17383170.

Global Initiative for Obstructive Lung Disease. (December 2009). Global Strategy for Diagnosis, Management, and Prevention of COPD. http://www.who.int/respiratory/copd/GOLD_WR_06.pdf.