COPD or chronic obstructive pulmonary disease has various stages. It goes through stage 1-4. In this regard, Dr. Hari Kishan Gonuguntla who is a Consultant Interventional Pulmonologist at Yashoda Hospitals Hyderabad said, “Early detection of COPD is critical to slowing the progression of the disease and in avoiding serious complications. There are four distinct stages of COPD: mild, moderate, severe and very severe. This is assessed using spirometry test, which check the patient’s lung function by measuring how much air you can breathe in and out quickly and easily you can exhale.”

Stages Of COPD And Their progression

Dr. Hari Kishan Gonuguntla said the following:

  • In stage1 or Mild COPD, the main symptoms are mild shortness of breath and on and off cough with or without mucus. This stage 1 COPD symptoms can easily be missed and be mistaken for some other disease entity.
  • Without proper treatment and smoking cessation, lung damage will continue and will progress to stage 2/ moderate COPD. Airflow limitation and symptoms progress in moderate COPD. Shortness of breath during physical activities is more noticeable and, cough and mucus production may increase. In addition to smoking cessation and pharmacological treatment, pulmonary rehabilitation is important in this stage for symptomatic relief of symptoms.
  • Once on the stage 3 or severe COPD, lung function has significantly decreased. Patient’s lung continue to weaken and will have abnormalities in gas exchange. Previous abovementioned symptoms are more intense and worsened. In addition, patient may experience extreme fatigue, chest tightness and more frequent respiratory infections. Patient may also experience more COPD exacerbations. This exacerbations are the leading cause of COPD-related hospitalizations.
  • The last stage is stage 4 or very severe COPD where the lung function is severely compromised and symptoms occurs even at rest. Some patients may even require long term oxygen treatment even at home to maintain oxygen saturation. More frequent exacerbations may occur and death may occur.

Smoking cessation is important in all stages of COPD to prevent further damage to the lungs. Updated vaccination for influenza and pneumococcal vaccine is also important to prevent and lessen respiratory infections that may cause exacerbations.

Different Stages Of COPD And How To Treat Them

Dr. Kuldeep Kumar Grover, who is the Head of critical care and pulmonology, at CK Birla Hospial, Gurugram said, “All these stages are depend upon severity, which means mild, moderate, severe and very severe. Mild means  you are not aware of this COPD, so a mild kind of cough has been started. COPD mild is easily treated by open own  medicine. One or other symptoms they have, they continue to occur, so there are four stages: mild, moderate, severe and very severe. Another thing is if it is a controlled then it is a controlled COPD, if it is the exacerbation COPD means uncontrolled COPD just fat medicine.”

Additionally, Dr.Ravindra M Mehta, who is a Senior Consultant, Pulmonology, at Apollo Hospitals, Jayanagar, Bangalore mentioned the following:

Stage 1 is early COPD and 4 is severe COPD with lung function less than 25-30%. The treatment of COPD depends on the stage it is at. Usually, you try to treat two basic aspects of patient issues.

  • One is symptoms- What are the symptoms: Is the patient short of breath? Are they coughing too much? Are they bringing up too much phlegm? Are they going through repeated issues with all this stuff?
  • The second issue we try to address is acute attacks or technically called exacerbations. So, in stage 1 or early-stage COPD, usually its hardly any symptoms. Patients are given broncho dilators or medications to make the airways open up more. But as the stages advance and the inhalers start begetting regular and often combination inhalers are used. And in the last stage of COPD,  maximal inhalers, nebulizers and so on maybe utilized.

“Other things which are very important and perhaps just as, if not more important compared to medication is the use of rehabilitation or pulmonary rehabilitation which is a graded exercise regimen over 12-24 sessions which is done under the supervision of an expert specialist. This exercise helps to improve their lungs and muscles and make them more functional. This is advised in stages of COPD 2-4,” he added.

Talking further, he said, “Other important things are non-invasive ventilation, oxygen therapy and preventive aspects such as vaccination. In a few COPD patients, procedures maybe offered which are bronchoscopic to try and improve their lung function or rarely surgical procedures. Finally in severe advanced, end stage COPD (also called lung failure), lung transplant maybe an option.”

Management For All Patients Of COPD:

Dr. Supreet Batra, who is the HOD & Senior Consultant Interventional Pulmonologist, Allergy & Sleep Specialist, at Batra Hospital listed the following:

Non pharmacological

  • Stop smoking
  • Avoid unhealthy air
  • Regular physical activity
  • Get your vaccines shot (Flu & pneumonia)
  • Eat healthy food (high protein & less carbohydrates)

Pharmacological Management (Step wise)

  • Bronchodilators – These medications relax your airways muscles and ease your breathing. They can short acting (SABASAMA) or Long acting (LABALAMA) and available in 3 forms – inhalers (combination inhalers), roracaps, respule for nebulisation.
  • Inhaled corticosteroids (ICS)- These medications reduce swelling & inflammation in your airway and are given in combination with bronchodilators for patients with multiple hospital admissionrecurrent attack
  • Combination inhalers – Now these are standard of care with combination of above medicines.
  • Oral steroids – Use in hospitalized patients with severe attacks
  • Phosphodiesterase – 4 inhibitors/Theophylline/Mucolytic/antioxidant agents – add on drugs to be used in patients with multiple attacks
  • Antibiotics – use only during infection

[Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]

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