Although chronic obstructive pulmonary disease (COPD) is a serious medical condition, many people can still live a healthy, happy life. As time passes, however, the disease eventually progresses to stage 4, or end-stage COPD. At this point, breathing becomes extremely difficult, and it's nearly impossible to live as active a life as you used to.
What is end-stage COPD?
There are three earlier stages of the disease before end-stage COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has established guidelines to differentiate the four stages of COPD, ranging from mild (GOLD 1) to very severe (GOLD 4).
In the fourth stage, or end-stage COPD, breathing capacity is diminished to about 30 percent or less, as compared with a healthy person. Other potential signs of end-stage COPD include:
- Becoming breathless while dressing and undressing
- Feeling too breathless to leave the house
- Coughing constantly
- Having a chest filled with mucus
- Feeling extreme chest tightness
- Having trouble sleeping
- Having a lack of energy or being extremely fatigued
Coping with end-stage COPD
Whether you have end-stage COPD or you're caring for someone else with the condition, coping with end-stage COPD can be challenging. But following a few simple strategies can improve life for everyone, including caregivers.
1: Quit smoking
If you have end-stage COPD, you may be tempted to continue (or resume) smoking. But many nicotine replacement therapies, such as gums or patches, are much easier on your lungs and can relieve the side effects associated with nicotine withdrawal. Even quitting at this late stage can make you more comfortable and able to enjoy a better quality of life.
2: Stick to your oxygen plan
In end-stage COPD, you'll most likely need supplemental oxygen to help you breathe almost all of the time. According to the Mayo Clinic, this is the only therapy proven to extend life for people with COPD. Using oxygen regularly can greatly improve your quality of life by making it possible to continue doing many activities that you would be unable to do otherwise. Look for a lightweight, portable oxygen unit that's easy to carry around as you move about.
3: Get support with emotional issues
Dealing with declining health is not easy for anyone, especially when coping with the frequent breathlessness, constant coughing and other unpleasant symptoms of end-stage COPD. It's no surprise then, that people living with COPD show higher levels of anxiety and depression than the general population.
These problems may only get worse as the disease progresses, so it's important to make sure you have adequate support. Consider finding a therapist or check out support groups in your area. You may also want to talk with your doctor about whether antidepressant or anti-anxiety medications would be an appropriate option.
The American Lung Association advises caregivers to be alert to the symptoms of anxiety and depression, often characterized by a persistent sad mood or a lack of interest in previously enjoyable activities.
4: Take steps to sleep better
The coughing and breathing problems related to end-stage COPD can also cause sleeping problems, including trouble falling asleep, trouble staying asleep and waking up feeling unrefreshed, notes the National Sleep Foundation. Like the rest of the population, sleep apnea also occurs in people with COPD (10-15%), which can further hinder a good night’s sleep. You may want to talk to your doctor about the use of a continuous positive airway pressure (CPAP) machine to improve the quality of your sleep.
5: Consider palliative care when the time is right
It’s difficult to determine just how long end-stage COPD will last -- it might be several months, or it could be several years. But as noted in the scientific journal Breathe, at some point, the type of care for end-stage COPD will change from treating the condition to making end-of-life comfort measures. This is often referred to as palliative care, and there’s no question that this can be a difficult decision to make. However, as symptoms worsen, and the need becomes more clear, it helps to have the support and objectivity of a team of trusted health care providers.
- COPD, Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685
- Global Initiative for Chronic Obstructive Lung Disease, 2018, https://goldcopd.org/wp-content/uploads/2018/02/WMS-GOLD-2018-Feb-Final-to-print-v2.pdf
- COPD and Emotional Health, American Lung Association, 2019, https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/living-with-copd/coping-with-emotions.html
- COPD and Difficulty Breathing, National Sleep Foundation, 2019, https://www.sleepfoundation.org/articles/copd-and-difficulty-breathing
- Sleep Apnea and COPD: What you should know, COPD Foundation https://www.copdfoundation.org/COPD360social/Community/COPD-Digest/Article/66/Sleep-Apnea-and-COPD-What-You-Should-Know.aspx
- Landers A, Wiseman, Pitama S, Beckert L. Severe COPD and the transition to a palliative approach, Breathe 2017(13): 310-316, https://breathe.ersjournals.com/content/13/4/310