End Stage COPD: What to Expect with Advanced COPD
Although there is currently no cure for COPD, treatments can manage symptoms and slow disease progression. For advanced COPD, there are also palliative care treatments and support. Disease progression varies, and each person with advanced COPD will have a different life expectancy that depends on many factors.
Family and friends, as well as the healthcare team, can provide support to people with advanced COPD while they are making end-of-life decisions.
This article discusses advanced COPD, including its symptoms, treatments, and outlook. It also contains a guide to coping with end-of-life decisions.
It is most commonly caused by smoking but can also occur due to air pollutants, genetic factors, and respiratory infections. As of 2018, it is the fourth leading cause of death in the United States, affecting close to 15.7 million people. It is more common in females than males.
Advanced COPD is the final and most severe stage of COPD. At this stage, quality of life is greatly reduced, and airway obstruction is at its worst.
COPD assessment is based on the severity of airflow limitation, clinical symptoms, history of exacerbations, and presence of comorbidities.
GOLD classifies the severity of airflow limitation based on spirometry testing. Spirometry testing measures the volume of air a person can expire in 1 second following a full inspiration (FEV1).
GOLD criteria are as follows:
- GOLD 1: FEV1 is at or above 80%.
- GOLD 2: FEV1 is at 50–79%.
- GOLD 3: FEV1 is at 30–49%.
- GOLD 4: FEV1 is under 30%.
The GOLD criteria further determine categories based on the level of symptoms. This involves evaluating:
- symptom assessment tests
- the number of severe exacerbations the person experienced in the previous year
- whether or not those exacerbations required hospital care
Your doctor may also order a chest X-ray to look at the state of your lungs or an arterial blood gas to measure the oxygen level in your blood.
Some people with advanced COPD are more likely to have severe symptoms that disrupt everyday activities. They have severe FEV1 impairment (FEV1 <30%) and breathlessness, even at rest, despite adequate medical therapy. That said, some people with severe FEV1 impairment are still able to function well in their daily activities.
Common symptoms that people with advanced COPD may experience include:
- anxiety or depression
- changes in breathing patterns
- changes in the level of consciousness
- confusion or memory loss
- cyanosis, or a bluish hue to the skin
- difficulty eating
- difficulty walking
- loud breathing
- muscle weakness
- shortness of breath
- difficulty swallowing
Complications of advanced COPD
Complications that are common with advanced COPD include:
- bacterial and viral lung infections, which cause acute COPD exacerbations
- pulmonary hypertension, which also affects the right ventricle of the heart
- weight loss
- other conditions or diseases
When symptoms are severe in advanced COPD, the person can lose weight and develop swelling in the ankles, legs, or feet. These symptoms can also occur as heart failure worsens with time.
Life expectancy with COPD depends on your age, your overall health, and the stage of your COPD at diagnosis. Although there are general life expectancy statistics available, your doctor can provide guidelines for your particular situation. Have an honest conversation with your doctor about your life expectancy and what you can do to improve your outlook.
People with mild COPD that is diagnosed early may live another 10–20 years after their diagnosis. For people with advanced COPD, their life expectancy is reduced by 8 or 9 years, on average. People who smoke or used to smoke also have lower life expectancies.
You can improve your life expectancy by quitting smoking. Make sure you get regular checkups and blood work to help control the inflammation caused by COPD.
Making other lifestyle changes — such as losing weight, eating a healthy diet, and participating in safe exercise — can also help.
Treatment for advanced COPD aims to reduce the symptoms and improve quality of life.
Medications such as bronchodilators may be used to help relax the muscles around your airways. For severe symptoms, an inhaler containing steroids can be used to reduce inflammation.
People with advanced COPD should receive vaccines for flu, pneumonia, whooping cough, shingles, and COVID-19, including boosters, as they are at higher risk of contracting these viruses. Talk with your doctor about what vaccines are right for you.
Antibiotics can treat a bacterial lung infection.
Oxygen therapy can help you breathe easier if you have severe symptoms of COPD. Some people with advanced COPD may need to use oxygen at all times to help them breathe.
Pulmonary rehabilitation can also be used to help manage disease symptoms and incorporate safe exercise into your daily routine.
For people with severe symptoms that medications have not helped, surgery is usually a last-resort option.
Surgery can be used to remove damaged lung tissue or remove large air spaces (called bullae) that form when air sacs are destroyed.
Some people with advanced COPD will need a lung transplant.
To improve their quality of life, people with advanced COPD may want to consider palliative care as an option.
Palliative care consists of a team of doctors, nurses, and social workers who work to alleviate your symptoms and discuss your goals for care.
Palliative care aims to keep you as comfortable as possible and improve your quality of life. Your palliative care team can help you with your medications and disease management and suggest lifestyle changes to incorporate while living with advanced COPD.
With advanced COPD, it is important to start thinking about end-of-life needs and final wishes for those close to you in your life. Having honest discussions with family members can help make sure that all your financial and legal affairs are in order and your final wishes are known.
An advanced directive contains a healthcare power of attorney and a living will. Your doctor can help you get an advanced directive form. With a healthcare power of attorney document, you can designate someone you trust to make healthcare decisions for you in the event that you are unable to do so.
The living will states your end-of-life medical wishes, such as whether or not you want to be resuscitated in the event of a cardiac arrest and what medical procedures you want or do not want.
Consider working with an estate planning attorney to appoint someone you trust to make decisions about your finances. It is important to store all your financial records in one place so that this person can access them easily. An attorney can also help you prepare your will to specify who you would like your belongings to go to.
Some other questions you may want to consider with end-of-life planning include:
- Where do I want to receive end-of-life care?
- At what point do I want to stop receiving medical treatment?
- Do I wish to be given a tube feeding if I am unable to eat?
- Do I want advanced life support, such as resuscitation or ventilator treatment?
While making end-of-life decisions, remember that you are not alone. Your healthcare team can help explain all of your options and assist you in making these decisions.
Advanced COPD is a progressive illness that results in difficulty breathing and poor quality of life. People with advanced COPD may experience shortness of breath, loud breathing, difficulty walking or eating, and cyanosis.
With advanced COPD, it is important to address end-of-life issues. This includes preparing an advanced directive, a living will, and a personal will or making sure that they are updated if you already have these. Your healthcare team can also help with the process of making end-of-life decisions by explaining the different medical choices to think about.
Palliative care for advanced COPD can help manage the symptoms, provide comfort, and improve quality of life.