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In Stage 1 of COPD, you might not even know there is something wrong. Stage 2 of COPD can also go undetected but your symptoms will become more severe and persistent. What do you need to know about Stage 2 of COPD?

Chronic obstructive pulmonary disease — COPD — is an umbrella term that covers several progressive lung diseases. COPD creeps up on patients slowly. In Stage 1, they may barely be aware that there is something wrong. Even Stage 2 of COPD can go undiagnosed for a while, but your symptoms will be harder to ignore than they were in Stage 1, and breathlessness is especially likely to plague you. You may also cough more severely and notice an excess of phlegm.

Over time, you'll notice that getting air in and out of your lungs becomes increasingly laborious. Stage 2 of COPD — also known as moderate COPD — may feature a lung function reduction of half to 79 percent. Now is the time to take action to maximize your quality of life. What do you need to know?

Stage 2 of COPD: What are the symptoms?

Patients in Stage 2 of COPD have ongoing and serious symptoms that are worse than the ones they experienced in stage 1. Some COPD patients develop additional symptoms, too, and these may include: 

  • Feeling more out of breath (dyspnea), particularly after you're physically active
  • More mucus that is also harder to get rid of
  • Increasingly intense and persistent coughs
  • A more limited airflow
In Stage 2 of COPD, the symptoms you already started out with in Stage 1 — whether or not you were diagnosed at that point — will become more intense and more frequent. If you haven't talked to a doctor yet, you'll probably feel the need to seek medical attention now because your symptoms will begin to interfere with your daily functioning. 

How is Stage 2 of COPD diagnosed?

Once you take the plunge and make that doctor's appointment, your physician will want to know about your smoking and medical history as well as your current symptoms, and run different types of physical tests on you. You will also be asked what airway irritants you might have been exposed to, like workplace dust or chemicals.

To determine if you have COPD, you will take a spirometry test — a non-invasive breathing test that will tell your doctor whether you have COPD and what stage you are in. You have stage 2 of COPD if the spirometry test shows that your forced expiratory volume in a second (FEV1) is around 50 to 79 percent.

Your doctor may also order blood tests, a chest X-ray, exercise tests, and a CT scan. These tests can tell your doctor more about your lung function and the way in which your COPD is affecting your overall health. They can also help your physician decide how to move ahead with your treatment plan. 

Stage 2 of COPD: What’s the best treatment plan for me?

Your treatment options for stage 2 of COPD resemble the ones that apply to stage 1, but you will have to make more serious changes in your lifestyle as your COPD gets worse — and new medications may be added to your regime, as well. 

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends the following treatment plan for moderate stage COPD. 
  • Stop smoking. If you smoke, stopping is the most important step you take to protect your health. Quitting smoking may not stop COPD in its tracks, but it will slow its progression and therefore maximize your quality of life. 
  • Long-acting inhaled bronchodilators may be introduced to your life during stage 2. The "rescue inhalers" you might have been using in Stage 1 of COPD relieve symptoms quickly, but long-acting inhalers will work to reduce your symptoms over a longer period of time. You can expect to use such inhalers once or twice daily, and this will work to make your life easier right now as well as reducing your risk of COPD flare-ups. The inhalers you may be offered can include formoterol (Foradil, Perforomist), aclidinium (Tudorza), and salmeterol (Serevent).
  • Combination medications that can include bronchodilators and corticosteroids can also be considered. 
  • Getting your annual flu shot and staying up to date on your pneumococcal vaccinations will reduce your risk of respiratory infections greatly, and thereby reduce your risk of COPD exacerbations. 
  • Pulmonary rehabilitation, a comprehensive program that includes exercise, nutritional advice, and education can make a big difference as well, both now and in the future.  

What should you do if you experience a COPD flare-up?

COPD flare-ups or acute exacerbations — periods of time during which your symptoms suddenly worsen — may also enter the stage in Stage 2. Ranging from mild to very severe, it is crucial that Stage 2 patients discuss the potential ways to manage flare-ups with their doctor before one hits, as these flare-ups can be extremely dangerous. 

For more intense COPD exacerbations, you may need:

  • Antibiotics. If your flare-up is caused by a bacterial respiratory infection, antibiotics are a crucial part of the treatment plan. 
  • Corticosteroids, which may be oral or inhaled, can work to relieve the symptoms you experience during a flare-up quickly. 
  • Supplemental oxygen.
  • In severe cases, you may require monitoring and treatment that can best be provided if you are hospitalized
Whatever treatment you end up needing, do not ignore a suspected COPD flare-up — rather, get in touch with your doctor right away. COPD exacerbations can become very serious, and may even be life-threatening, so timely treatment is of the essence. 

What else should you know during Stage 2 of COPD?

If you have chronic obstructive pulmonary disease, your risk of heart disease, hypertension, and lung cancer rise as well. COPD patients are also at a higher risk of becoming depressed. Once diagnosed, it is important to attend regular checkups with your doctor, as well as sounding the alarm bells when you think something new is wrong. Additionally, talk to your physician about how you can decrease your risk of COPD-related complications. 

  • Ferguson, Gary T. Maintenance pharmacotherapy of mild and moderate COPD: What is the Evidence?
  • Respiratory Medicine. 105, 1268-1274.
  • Photo courtesy of SteadyHealth

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