COPD is a disease that can be managed but never cured. As a result, it is important for health professionals to observe patients who appear to be at risk for COPD with extra care, to curb behaviors that can lead to a worsening of COPD, or “exacerbations” (severe episodes) that can lead to hospitalization, critical care, and even death.
COPD Symptoms Follow a Predictable Pattern
The symptoms of COPD may intensify over time, but follow a general pattern. COPD sufferers often notice the onset of the disease as tightness in the chest that causes excessive coughing, often with mucus. This will be followed by shortness of breath, at first when exercising or walking upstairs, but eventually when performing any kind of physical activity. Shortness of breath often leads to what physicians call “barrel chest”. Some COPD sufferers may experience feelings of choking, wheezing, or waking up out of breath. In addition, many people with COPD will have “flares”, during which chest tightness increases, breathing worsens, and the typical COPD posture becomes “tripodal”; sitting, leaning forward and down with forearms on legs to ease breathing. At this stage, COPD sufferers may notice a bluish tinge to their lips fingers, or fingernails. These episodes and symptoms are considered an emergency.
COPD, like many diseases, is progressive. One year a person notices a little shortness of breath on a hot, humid summer day. Five years later, that same person may be confined to a wheelchair and tethered to an oxygen-generating machine. Sadly, this is the only way to insure a continuous flow of oxygen: portable, rechargeable machines are both a very recent development and only hold their charge for two hours (or about the same amount of time as a large oxygen bottle, M-24, flowing at 2.0 liters per minute, or LPM).
From 1 to 4, or “End-Stage” COPD
Typically, COPD is staged via a breathing test known as spirometry. By comparing a person’s FVC (for forced expiratory volume) to their FEV1 (forced expiratory volume in one second), doctors can stage COPD. The FEV1 is based on normal oxygen levels for a healthy Caucasian male.
• In stage 1, also known as very mild COPD, the FEV1 is more than 80 percent of normal.
• In stage 2, moderate COPD, the FEV1 is between 50 and 80 percent of normal, and sufferers may experience some shortness of breath with exercise or exertion.
• In stage 3, severe COPD, the FEV1 is between 30 and 50 percent of normal, and victims are often tired and breathless. They may also have frequent exacerbations.
• In stage 4, also sometimes referred to as “end stage” COPD, FEV1 is less than 30 percent of normal and sufferers will need continuous oxygen therapy. In stage 4, COPD victims may also experience hypoxia, or even hypercapnia. This is a result of not being able to breathe out properly, which means carbon dioxide stays in the lungs. Too high levels of carbon dioxide can be lethal, so most COPD victims require emergency care when this happens, and may eventually need surgery to repair the diaphragm, which controls breathing out and in.