Managing the 4 Stages of COPD
Key Takeaways
- Chronic obstructive pulmonary disease (COPD) is a condition that affects millions of U.S. adults and is one of the top causes of death around the world.
- Over the 4 stages of COPD, symptoms like coughing and shortness of breath can become more severe.
- You may need treatments like medication, rehabilitation, and portable oxygen to manage your COPD symptoms.
- Medicare provides coverage for COPD treatment, but you will need either a Medicare Part D plan or a Medicare Advantage Prescription Drug plan for medication coverage.
According to the Centers for Disease Control and Prevention (CDC), almost 16 million U.S. adults have been diagnosed with chronic obstructive pulmonary disease (COPD). This condition is one of the leading causes of death worldwide. Recognizing COPD signs could be crucial to maintaining your health and quality of life as you age.
The four stages of COPD are one way to classify the severity of your condition. Depending on which stage you’re in, you may need different types of treatment and face more serious health risks. When you’re aware of COPD signs and symptoms, you can take action to ensure you have the right care and health insurance coverage.
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What Is COPD?
COPD is a term used for several types of lung disease that interfere with airflow to your lungs, making breathing harder. The most common types of COPD are:
- Emphysema: In emphysema, there’s damage to the walls of the alveoli, the sacs in your lungs that fill with air when you inhale.
- Chronic bronchitis: In chronic bronchitis, the bronchial tubes that transport air into and out of your lungs become inflamed.
These conditions are most often caused by smoking tobacco, but other risk factors include exposure to chemical breathing hazards in the workplace and asthma.
Symptoms of Chronic Pulmonary Disease
COPD symptoms frequently include:
- Coughing with mucus or phlegm
- Shortness of breath
- Trouble breathing
- Wheezing
- Feeling tightness in the chest
People with COPD sometimes have exacerbations, which are periods when their symptoms become worse than usual. During these flare-ups, you might cough and wheeze more, feel increased shortness of breath and fatigue, see changes in your phlegm or mucus, and have trouble sleeping.
If your COPD becomes severe, you may experience chronic respiratory failure, which is when problems with your lung function result in either too little oxygen or too much carbon dioxide in your blood. This serious illness can affect your breathing and your heart rhythm and even lead to a coma.
What Are the 4 Stages of COPD?
The Global Initiative for Chronic Obstructive Lung Disease (GOLD), a program from the National Heart, Lung, and Blood Institute and the World Health Organization, defined the criteria for the stages of COPD. The GOLD system classifies COPD as stages one through four based on the results of a spirometry test, which measures how much breathing is obstructed and the severity of symptoms.
In a spirometry test, you breathe into a spirometer, a device with a mouthpiece that checks your:
- Forced vital capacity: How much air you can exhale after a deep inhale
- Forced expiratory volume: How much air you exhale in the first second
If the forced expiratory volume ratio over the forced vital capacity is less than 0.7, you may be diagnosed with COPD. By considering your spirometry results along with your symptoms, a doctor can assess what stage of COPD you’re in.
COPD stage | Forced expiratory volume | Symptoms |
Stage 1: Mild | 80% or more of the expected reading | You may have a cough or increased mucus, but people at this stage often don’t even realize they have problems with lung function. |
Stage 2: Moderate | 50-79% of the expected reading | Symptoms start to worsen, including shortness of breath when you exercise or engage in other strenuous activities. |
Stage 3: Severe | 30-49% of the expected reading | Shortness of breath may get bad enough to interfere with everyday tasks. You’re likely to have exacerbations. |
Stage 4: Very severe | Less than 30% of the expected reading or less than 50% with chronic respiratory failure | This stage usually occurs after years of living with COPD. The condition becomes seriously detrimental to quality of life and exacerbations could be fatal. |
COPD Therapy
While there’s no cure for COPD, you can work with your doctor to manage symptoms and slow the condition’s progression. Your treatment plan will likely involve lifestyle changes like:
- Stop smoking: If you still smoke, quitting is the most crucial step you can take to improve your condition.
- Avoid triggers for exacerbations: Air pollution, pollen, scents from deodorant or cleaning supplies, high humidity, cold weather, storms, and respiratory infections are all examples of triggers that could cause a flare-up in COPD symptoms when the condition becomes severe. Keeping up with all recommended vaccinations may prevent illnesses like the flu, pneumonia, or COVID-19 that might worsen your condition.
- Attend a pulmonary rehabilitation program: In either group or individual sessions supervised by healthcare providers, you’ll get answers to your questions, learn breathing techniques, and receive psychological and nutritional counseling. Exercise training can help to build your strength, stamina, and flexibility to make everyday activities more manageable.
Along with these changes, your doctor might prescribe a variety of medications to minimize the symptoms and complications from COPD, which could include:
- Bronchodilators: Usually administered with an inhaler, these drugs relax the muscles around your airways so you can breathe more easily and also clear mucus from your lungs to relieve coughing.
- Corticosteroids: Inhaled steroids are used to lower inflammation, mucus, and swelling in the airways. They’re generally prescribed in combination with a bronchodilator. In some cases, you might be prescribed a corticosteroid in a pill for short-term treatment of an exacerbation.
- Roflumilast: This medication can reduce inflammation in people with severe COPD, preventing exacerbations.
- Antibiotics: Since respiratory infections worsen COPD symptoms, it’s important to treat them with antibiotics.
You may need a portable oxygen tank if you have low blood oxygen levels. Some people with severe COPD use this supplemental oxygen during certain activities or while they sleep, while others with more advanced cases may need help breathing throughout the day.
Medicare Coverage for COPD Treatment
Most U.S. adults who are over 65 years old or have certain disabilities get their health insurance either through the federally administered Original Medicare program or a Medicare Advantage plan from a private insurance carrier. Original Medicare consists of Medicare Part A hospital insurance and Medicare Part B medical insurance.
Original Medicare and COPD
Medicare Part B covers outpatient treatment for COPD, including:
- Appointments with your primary care doctor and specialists, as long as they accept Medicare.
- A comprehensive pulmonary rehabilitation program for people who have moderate COPD or worse.
- Rental of oxygen equipment.
For most services and durable medical equipment covered by Part B, you’ll pay 20% of the Medicare- approved cost after meeting the annual deductible.
Medicare Part A covers your stay if you need to be hospitalized because of an exacerbation of your symptoms. After you meet the Part A deductible, Medicare pays the costs of hospital services for the first 60 days. For more extended stays, you will begin to pay daily coinsurance.
Original Medicare provides coverage for medications administered in a clinical setting like the hospital or a doctor’s office. However, for most drugs prescribed to manage COPD symptoms at home, you need either a Medicare Part D plan or a Medicare Advantage Prescription Drug plan from a private insurance carrier.
Medicare Advantage and COPD
Medicare Advantage plans are legally required to at least match Original Medicare coverage, including for COPD treatment, and they may offer additional benefits. To make full use of your benefits, you will need to see healthcare providers that are in your plan’s network.
Depending on where you live, you may have access to a type of Medicare Advantage plan called a Chronic Condition Special Needs Plan (C-SNP). A C-SNP is designed to provide coordinated care and drug coverage for people with certain chronic conditions like COPD and may feature a range of other benefits.
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Putting It All Together
COPD is a potentially debilitating condition and one the world’s top causes of death. By learning how to manage the 4 stages of COPD, you can make a big difference in the progression of symptoms and your overall quality of life.