Treatment Options for Stage III or Severe COPD

Treatment Options for Stage III, Severe COPD

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If you have been diagnosed with severe COPD, you probably have a lot of questions. Maybe you presented them to your doctor and are still not clear on what to expect, a concern that is fairly common with the newly diagnosed. After you recover from the initial shock, you will, most likely, be ready for some answers.

The disease is classified into four stages: Stage I, mild COPD, Stage II, moderate COPD, Stage III, severe COPD and Stage IV, very severe COPD.

Being in Stage III means that your FEV1 to FVC ratio as measured by a lung test known as spirometry should fall below 70% and your FEV1 should be somewhere between 30 and 49 percent. People with severe COPD often have worsening shortness of breath, a reduced tolerance to exercise, greater fatigue-ability and more frequent episodes of COPD exacerbation that severely impact the quality of life.

Specific treatment guidelines are recommended by the Global Initiative for Obstructive Lung Disease (GOLD) for each stage of the disease. Listed below are the GOLD recommended treatment options for Stage III, severe COPD:

Smoking Cessation

Smoking cessation is the primary goal of treatment for COPD no matter how far advanced the disease. Not only does quitting help slow the progression of the disease, but it has many other health benefits as well.

Flu and Pneumonia Vaccines

Flu and pneumonia vaccines are highly recommended for people with all stages of the disease. Flu shots help reduce the risk of COPD exacerbation, and the pneumonia vaccine reduces your chances of acquiring bacterial pneumonia, a common cause of COPD exacerbation.

Short-Acting Bronchodilators As Needed

Short-acting bronchodilators like Albuterol or Proventil are important to help you manage persistent or worsening COPD symptoms. Commonly referred to as rescue inhalers, these medications are among the gold-standard of treatment for Stages I through IV of the disease.

One or More Long-Acting Bronchodilator

Long-acting bronchodilators are commonly used as the disease progresses to help you prevent or reduce symptoms. Your doctor may recommend that you combine bronchodilators with different modes of action because this method may be more effective, with equal or fewer side effects, than using just one bronchodilator alone. Listed below are some examples:

Long-Acting Beta Agonists

Long-Acting Anticholinergics

Pulmonary Rehabilitation

Pulmonary rehabilitation is added at Stage II of the disease and is also recommended for the advanced stages. Studies have suggested that pulmonary rehab helps people with COPD reduce symptoms, improve the quality of life, decrease social isolation and increase survival.

The program generally consists of exercise training, nutritional counseling, and education and utilizes a multidisciplinary team of healthcare workers, including nurses, physical and occupational therapists, dieticians and counselors.

Inhaled Glucocorticoids

The use of glucocorticoids in the management of COPD is controversial, but your doctor may add them in the inhaled form (per GOLD guidelines) during Stage III if you have frequent exacerbations.

The Importance of a Healthy Diet

People with severe COPD often have a harder time breathing than when they were in the earlier stages of the disease. This, in turn, increases their energy requirement, which is why eating a healthy diet is so important. Eating right can also reduce the risk of lung infection, a common cause of COPD exacerbation.


Global Initiative for Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of COPD. Updated 2010.

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