COPD is a lung disease that progresses gradually through four stages. In the early stages, it may be mild and resemble a cough. In the very severe stages, frequent flare-ups can lead to heart or lung failure.
It’s difficult to pinpoint the exact timeframe for the progression of the disease. If you’re wondering how fast COPD progresses, you should take general health and wellness into account, including lifestyle factors like smoking. However, it usually develops and progresses over the course of several years.
Though you cannot reverse the course of COPD, it’s possible to slow its progress with a treatment plan created together with a healthcare professional.
Stages of COPD
There are four stages of COPD. A spirometry test, which measures the flow of air through the lungs, determines which stage you’re at.
The spirometer measures two important numbers: the force vital capacity (FVC) and the force expiratory volume in one second (FEV1). FVC is the amount of air you can breathe out overall in one try, and FEV1 is the amount you can breathe out in one second. For a COPD diagnosis, the ratio of FEV1/FVC must be less than 0.7.
However, the stages are graded according to the FEV1 score only. These are:
- Early stage (stage 1): In this stage, it’s possible to be unaware that you have the condition. This is classified as stage 1 COPD based on an FEV1 reading of 80–100%.
- Mild stage (stage 2): This is the stage that typically brings people to the doctor with an increase in coughing, mucus production, and shortness of breath. This is classified as stage 2 based on FEV1 dropping to 50–79%.
- Severe stage (stage 3): In this stage, daily activities are impacted by shortness of breath and coughing. In stage 3, the FEV1 drops to between 30 and 50%.
- Very severe stage (stage 4): In this stage, daily activities will be even more severely affected. Breathing will become more difficult even without any exertion, with an increased risk of heart and lung failure. In stage 4, FEV1 levels will be lower than 30%.
The speed that you’ll progress from one stage to the next is unknown and depends on a variety of factors, including treatments and whether you avoid triggers. Some research indicates that it can take 10 years or longer to progress from the mild stage to the very severe stage.
However, worsening COPD is strongly linked to continuing to smoke, while quitting can slow the progression of the disease.
In addition, some research has found that certain combinations of biomarkers in your blood can help doctors predict things like disease progression and severity. However, research is ongoing, and it’s still unclear how these can be used to determine COPD progression.
Computed tomography (CT) imaging has also been used to identify COPD severity in different populations, which can help doctors learn more about disease progression in different individuals, including how quickly it may progress. It can be used as an aid, but spirometry is still used to determine COPD stages.
COPD symptoms
Symptoms progress in accordance with the stage. In the early stage, it may not be obvious you have COPD at all, or the symptoms could mimic a cough, so you might not consider it a cause for concern.
The mild stage is when people are typically diagnosed due to an increase in symptoms. Then, symptoms of coughing, difficulty breathing, and fatigue increase in stage 3, along with swelling in the ankles, chest tightness, and wheezing.
In the very severe stage, it is possible to experience trouble breathing even in a resting state. During this time, being on oxygen all the time may be recommended.
COPD treatment options
Since COPD is not curable, the goal of treatment is to manage the symptoms, improve the quality of life, and slow progression. However, for COPD patients in particular, research shows that the rate of people not sticking to their treatment may be as high as 80%.
For smokers, the best way to slow the progression of COPD is to stop smoking. Non-smokers are encouraged to avoid secondhand smoke and other lung irritants.
Everyone with COPD, during all stages, is encouraged to get flu and pneumonia vaccines to avoid respiratory illnesses that could make symptoms worse. Maintaining a healthy weight and getting regular exercise to help keep the respiratory muscles strong is also recommended.
In the early and mild stages, a doctor may prescribe bronchodilators, a medication to help open the airways. It is typically taken through an inhaler or nebulizer. Later stages may require steroids or oxygen. In the last stage, lung surgery may be recommended to improve breathing.
The three most common types of bronchodilators for COPD are:
- beta-2 agonists, such as formoterol (Perforomist) and vilanterol (Breo Ellipta)
- anticholinergics, such as ipratropium and tiotropium
- theophylline (Theo 24)
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