Chronic obstructive pulmonary disease can be separated into four stages, starting with very mild symptoms that gradually worsen over time until patients reach the most severe stage. Each stage of COPD comes with its own treatments that will literally and figuratively help you breathe more easily and reduce your odds of experiencing execerbations. For this reason, it's important to let your doctor know whenever you begin noticing new symptoms or your symptoms worsen.
Stage 1: Mild COPD
Many Stage 1 COPD patients will still be unaware that they have the disease. They may notice a persistent cough or the presence of more mucus, but to untrained eyes, these symptoms are easily attributable to other causes like a passing cold.
Medically, your doctor may recommend the following steps if you're diagnosed with Stage 1 COPD:
- Quitting smoking!
- Breathing exercises to help you manage shortness of breath.
- Annual flu shots will be strongly encouraged, and people with COPD should also stay up to date on pneumococcal vaccines.
- Short-acting bronchodilators (inhalers), which open up the airways quickly when you're wheezy or out of breath. The "relief" inhalers prescribed to COPD patients include albuterol (Ventolin, Proventil, AccuNeb), albuterol sulfate (ProAir HFA, ProAir RespiClick), and levalbuterol (Xopenex).
- Short-acting bronchodilators comibined with a muscarinic antagonist, like Combivent (albuterol and ipratropium) or Duoneb (albuterol and ipratropium). These may be prescribed of inhalers, which themselves come in different kinds, as well as liquids or tablets.
Stage 2: Moderate COPD
Stage 2 of COPD is characterized by persistent cough, excess mucus production, and shortness of breath. If you experience these symptoms but haven't received a diagnosis yet, do not continue to dismiss them as normal aging or harmless respiratory infections — see your doctor now!
For diagnosed patients, recommended treatment will continue to include everything that was present in Stage 1. You may also:
- Receive advice on steering clear of triggers that make your symptoms worse — including possible workplace exposure and air pollution.
- Be introduced to long-acting bronchodilators, which are designed to keep your airways open for longer periods of time. You'll use these at predetermined times every day, and they include LABAs (long-acting beta2 agonists) and LAMAs (long-acting muscarinic antogonists). LAMAs you may be prescribed are Incruse (umeclidinium), Seebri (glycopyrrolate), and Spiriva (tiotropium), while some common LABAs are Arcapta (indacaterol), Brovana (arformoterol), and Perforomist (formoterol). You may be prescribed a combo of the two.
- Be referred for pulmonary rehabilitation. This includes exercises and suggestions for lifestyle changes that will help you achieve the best quality of life you can have as a COPD patient. It becomes more important as your symptoms get worse.
Stage 3: Severe COPD
Stage 3 COPD patients are living with a very significantly reduced lung function, already. This means worse symptoms that impact your life more, and also the possibility of acute exacerbations.
Treatment is likely to involve:
- Short-acting relief inhalers as well as long-acting bronchodilators, and everything else recommended for people with milder COPD.
- Steroids, which can be oral, like prednisone (Prednisone Intensol, Rayos), hydrocortisone (Cortef), or prednisolone (Prelone), but also self-administered as an inhaler, like beclomethasone dipropionate (the Qvar Redihaler), budesonide (the Pulmicort Flexhaler), or fluticasone propionate (Flovent).
- Expectorants may be familiar to you as cold meds. They basically make you cough more, which means you'll get rid of excess mucus more easily. They're sometimes recommended to COPD patients not just because clearing mucus helps you breathe better but also because it lowers your odds of infections.
Stage 4: Very severe COPD
In addition to all the treatments you will have received in the earlier stages, you could also be advised to try:
- Oxygen therapy. This is for patients whose blood oxygen levels aren't sufficient. It's a big step, but it can help you be less out of breath, tired, and more alert.
- Surgery. Certain kinds of lung surgery can help certain COPD patients achieve a better quality of life. In a bullectomy, damaged airsacs are eliminated to help you breathe more easily. A lung volume reduction surgery, or LVRS, may be suitable for patients with severe emphysema in their upper lung lobes, and then, finally, some patients will be candidates for a lung transplant.