Same Devil, Different Levels - Same Level, Different Devils

The severity of COPD is normally determined by breathing tests. These tests are used to determine the stage of your COPD. There are 4 stages listed and accepted by medical profession as the standard by which symptoms of your COPD are measured. If you are unfamiliar with the stages, symptoms and limitations attached to each stage, COPD.net has written a very informative article that can be accessed by following this link. For those of you who are unaware of your stage it will give you a starting point to gauge where your COPD may be at this time. However remember the symptoms and limitations described in each of the 4 stages may or may not be the same ones you are actually having. No matter what stage of COPD your breathing tests indicate you are in, the symptoms described are only a guide as to what you might or might not expect in that stage.

First let me tell you that COPD consists of two main conditions- emphysema and chronic bronchitis. When you have COPD you can have only one of them, both of them, or you can have COPD with underlying conditions that affect how you will feel in each of the different stages.

Many times COPDers in the same stage and at the same level in that stage can experience totally different symptoms & COPDers at different level and stages can be having the same symptoms.

The type of COPD you have will have an effect in determining which of the symptoms you feel and how strong they may become. Both emphysema and chronic bronchitis share some symptoms, but also have some symptoms that are different.

Symptoms of emphysema include:shortness of breath, a dry cough that may be unproductive, wheezing, chest pain, exercise intolerance, and a decrease in exercise may cause muscle wasting and atrophy. Not all people with emphysema notice shortness of breath, but instead they are unable to be as physically active as they once were, for example, it becomes difficult to walk as far or to climb as many flights of steps.

Symptoms of chronic bronchitis include: cough and sputum production daily, shortness of breath with activity, wheezing, fatigue, sore throat, muscle aches, nasal congestion, headaches, severe coughing causing chest pain, and frequent viral or bacterial lung infection - this is often referred to as an exacerbation.

Underlying physical, environmental, medical, and emotional conditions will also affect how COPDers at stage II can have the same symptoms as a COPDer in stage III/IV and how being influenced by one or more of the aforementioned conditions will affect people at the same level of COPD in totally different ways.

Here is one example of how two people that are at the same stage and level of COPD might have differences. My one-time companion Fred, like myself, was stage IV COPDer with an 18% breathing capacity, we were both on 2L of oxygen. The difference between us was I had emphysema complicated by asthma and CHF (congestive heart failure). Fred on the other hand suffered from both Emphysema and Chronic Bronchitis.

Although we were both at 18% breathing capacity and felt many of the same symptoms described for a person with stage IV COPD, each of us developed symptoms completely different from the other. Fred for instance (due to the fact he had chronic bronchitis) experienced a huge amount of coughing, trouble bringing up mucus, and infection every few weeks requiring a visit to the ER/hospital. I on the other hand in the 18 months we knew each other never had one infection or require any visits to the ER/hospital. I very seldom coughed and when I did it was dry and unproductive. Although Fred and I were both lower stage IV, we were still very involved in everyday activities. During our outings, other then becoming SOB, Fred was good to go. I not only got SOB, but, we had to be careful not to go anywhere that would trigger my asthma and many times when we went on group outing I had to wear a mask and sit away from the others.

On shopping trips, Fred carried all the things into the house. He became SOB, but once in the house and he did some purse lip breathing, he recovered quicker. My COPD in combination with my CHF put such a strain on my breathing that just walking up the steps to his house would cause my FEV1 to drop to a very low-level and my heart rate to go well into the hundreds. By the time I got to the top of the steps, I had to go on my BiPAP. It could take up to 30 minutes for me to get back to a state where I was able to do anything. Sometimes after an outing I had to remain on a BiPAP for several hours. Although we were both at the same stage and level, the challenges we had dealing with our COPD was completely different. Fred had to deal with frequent infections, hospitalizations, severe and continued coughing, and the inability to bring up mucus clogging his lungs. While the hardest challenges for me were protecting myself from surrounding environmental triggers and the extreme effect the slightest bit of exertion has on my body and the fear of my going into cardiac or pulmonary arrest.

We had the same level just different devils.

Anyone who has read any of the articles I've written knows I belong to several different groups. A lot of the information I gain is form my interaction with members of those groups. Most COPDers that are in stage I, II, III, do not require supplemental oxygen. There are however always the exception to that rule such as one woman recently who is a stage II and her doctor prescribed her supplemental oxygen, because of her becoming short of breath. A reason for this could be because she is extremely overweight which has a major affect on someone with COPD. Under most circumstances if she was of normal weight at her stage she would not require supplemental oxygen. She also described becoming very fatigued performing every day tasks. She is stage II, but many of the symptoms she is experiencing are those of stage IV.

Another gentleman I know is also stage II of normal weight, however, he smokes and his job exposes him to COPD environmental triggers such as carbon monoxide, gasoline, and other chemicals. These triggers have caused him to experience many symptoms associated with the stage III COPD. Such as SOB, becoming easily fatigued, heavy coughing and mucus production. He is also beginning to experience multiple exacerbations. Unfortunately, he is overusing his rescue inhaler to enable him to get through the day and complete his job.

Another friend is stage III, like the woman I described above with stage II on oxygen, so is she. Like the gentleman I described above stage II, she experiences SOB, fatigued easily, has multiple exacerbations, and unfortunately she too overuses her rescuing inhaler and still smokes. Everyone knows I'm a stage IV, and although on a different level I have symptoms similar to all of the above-mentioned. I get SOB very easily, I'm on supplemental oxygen, I fatigue easily, some of my main triggers are the same as the gentleman I described. We are all at different levels however we experience many of the same devils.

I have had people contact me in stage II and stage III and upper stage IV whose lung capacity is much higher than my own but they take more medicine than I do, are less active than I am and don't understand why there seems to be such a difference in their conditions. The best answer I can give them is when it comes to COPD the guidelines don't take into consideration the underlying factors that affect the symptoms and abilities of the individuals COPD, are how differently the two main conditions associated with COPD can affect the stage you are in. If he only have Emphysema, chances are you won't have many of the symptoms described such as frequent infections heavy coughing and production of mucus. When you just have emphysema they are not a major concern. However if you have chronic bronchitis the multiple infections that visits back and forth to the ER/hospital, the constant coughing and choking you are well acquainted with. Most of the medical profession consideration a patient is having COPD even if they only have one of the components instead of both. I feel that if the person only has emphysema then they should not be given COPD guidelines because chances are they would not experience a lot of the symptoms described in those guidelines. If you realize not everyone who has COPD has both emphysema and chronic bronchitis and will go a long way in explaining why COPDers at the same stage and level are experiencing different devils.

I no longer have chronic bronchitis so I do not experience the infections, exacerbations, visits to the ER at hospital, bouts of antibiotics and steroids, that many of you with COPD experience can live with every day. Although I don't experience any of the above-mentioned I have to sleep with the non-invasive ventilation machine every night and over the last few months I spend a good portion of my day on a ventilation machine. When I do make it out to lunch, I'm on my ventilation machine for at least two hours when I come home. Most COPDers in stage IV are not on ventilating machines (a CPAP is not a ventilating machine), and never will be. But they experience most of the other things I mentioned. And the truth be told I would rather have to use my ventilating machine for a few hours every day rather than go through the merry-go-round of ER/hospital trips, antibiotic, infection, and exacerbations. It's just another case of the same levels different devils. Although both are debilitating, I prefer my devils to yours, lol.

COPD is an individual disease, I have yet to meet any two people with COPD would have the exact same symptoms and have reacted exactly the same to this horrible disease.

Everyone of you should know not only your stage and level but what component of COPD do you have - you have just one or both, and what underlying condition you have that has an effect on your COPD. I have said many times before: learn all you can about your condition in "YOUR COPD" as it is different from everyone else's COPD.

None of us have the exact same body or same conditions in our lives and COPD will not affect us all the same. So use the symptoms described in the GOLD stage chart as a guide to what might happen at each different stage not what will happen. You have to take into account all the outside factors that will affect your COPD. If you're stage I or stage IV you may or may not experience the symptoms described for that stage. No matter what your stage or level we all deal with our own set of COPD devils. Breathe deep and easy.

Editor’s Note: We are extremely saddened to say that on March 2, 2018, Mary Ultes passed away. Mary was an engaged advocate for the COPD community who strived to help people live fulfilling lives. She is deeply missed.