Treatment for Very Severe COPD

Stage IV, Very Severe COPD Treatment Options

If you have been diagnosed with Stage IV, very severe COPD, your FEV1 to FVC ratio as measured by spirometry is likely below 70% and your FEV1 is less than 30% predicted, or less than 50% predicted with chronic respiratory failure. People who have very severe COPD often suffer from frequent, life-threatening exacerbations that dramatically impair their quality of life.

The Global Initiative for Obstructive Lung Disease (GOLD) recommends specific treatment guidelines for each stage of the disease. Here are the recommended treatments for Stage IV, very severe COPD:

It's Never Too Late to Quit Smoking

Even if you are diagnosed in the advanced stages of the disease, it's NEVER too late to reap the rewards of smoking cessation. Not only does quitting help slow the progression of the disease, but it has many other health benefits as well.

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Flu and Pneumonia Vaccines

Flu and pneumonia vaccines are among the GOLD treatment guidelines for every stage of the disease. Flu shots help people with COPD reduce the risk of COPD exacerbation and the pneumonia vaccine helps lower your chances of developing bacterial pneumonia, a common cause of COPD exacerbation.

Short-Acting Bronchodilators

Rescue inhalers containing short-acting bronchodilators like Albuterol or Proventil help people with COPD manage persistent or worsening COPD symptoms.  These medications are part of the standard of care for all stages of the disease.

Long-Acting Bronchodilators

As COPD progresses, your doctor may add one or more long-acting bronchodilators to help you prevent or reduce your symptoms. While using only one long-acting bronchodilator is safe, using a combination with different modes of action may be more effective, with equal of fewer side effects.

Long-Acting Beta Agonists

  • Salmeterol
  • Formoterol

  Long-Acting Anticholinergics

Pulmonary Rehabilitation

Pulmonary rehabilitation is generally added during Stage II of the disease, but is recommeand in the advanced stages as well. Pulmonary rehab helps reduce COPD symptoms, improve quality of life, decrease social isolation and increase survival in some patients. The program uses a multidisciplinary approach offering exercise training, nutritional advice, education and counseling utilizing nurses, physical and occupational therapists, dieticians and counselors.

Inhaled Glucocorticoids

Treatment with glucocorticoids, commonly referred to as steroids, is controversial, but GOLD recommends them in the inhaled form once you reach Stage III if you suffer from frequent exacerbations.

The Pros and Cons of Glucocorticoids in the Treatment of COPD

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Oxygen Therapy

Oxygen therapy is recommended in Stage IV on a continuous basis, during exercise and/or to relieve sudden episodes of shortness of breath. Continuous oxygen is generally recommended for those whose PaO2 (as measured by arterial blood gases) is 55 mm HG or less as measured by arterial blood gases or, whose oxygen saturation levels are less than or equal to 88 percent.

Lung Surgery

There are three types of lung surgery available to those who meet very specific criteria with Stage IV COPD. Post-operative complications are common and the risk increases due to smoking, poor, overall health, increased age, obesity and the severity of the disease.

Healthy Nutrition

Healthy nutrition is important for everyone, especially for people with Stage IV COPD who, because they need extra calories just to breathe, may have a higher energy requiement than other people. A healthy diet also reduces the risk of lung infection, a common cause of COPD exacerbation and prevents malnutrition, a common complication of COPD during this stage. 


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

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