Understanding Your COPD Diagnosis: Stages, Tests, and Next Steps

COPD stands for chronic obstructive pulmonary disease. At this time, this is a progressive disease without a cure. Falling under the umbrella of COPD are emphysema, chronic bronchitis, and Alpha-1 Antitrypsin Deficiency, which is the genetic form of COPD.

Understanding COPD testing and staging

When you take a pulmonary function test, the results include FVC (forced vital capacity). This is when you inhaled, when you took a deep breath in. When you exhaled during that first second, those are the results from your FEV1 test. FEV1 represents one second of exhalation. The numbers from this test help determine the stage that you are in.

The most commonly used COPD staging model has four stages

• Stage 1 Mild FEV1 is 80% or greater
• Stage 2 Moderate FEV1 is 50% - 79%
• Stage 3 Severe FEV1 is 30% - 49%
• Stage 4 Very Severe FEV1 is 29% and below

Explaining the staging model

Stage 1 COPD: Mild Symptoms and early signs

Stage 1 is the mild stage. A person in this stage might not realize that they have a lung disease. Someone in this early stage might find themselves short of breath, wonder why they have mucus since they don’t have a cold, and they may be coughing more. Some questions to ask and a potential progression are as follows:

• Is the person a smoker? Many would attribute their symptoms to smoking, especially the shortness of breath and the coughing.
• There will come a time when this person realizes they aren’t feeling better and may be getting worse. They may think it's time to go to the doctor for an antibiotic or something.
• Nothing is really helping. The doctor will likely do x-rays and possibly a CT scan. It’s obvious to the doctor that there is reduced airflow. Further testing needs to be done.
• Your doctor may give you a rescue inhaler.

Stage 2 COPD: Moderate progression

Stage 2 is the moderate stage. This is the stage that I was in when diagnosed with COPD. This is the stage where a person might feel more shortness of breath, and may be weary. There may be more coughing. It seemed like I was being tested and going to the doctor more often. Oxygen levels and blood pressure are checked at every appointment. Here are some considerations for stage 2:

• If a pulmonary function test or PFT hasn’t been given yet, now is the time. This is the test where you are put in a glass enclosure that resembles a telephone booth. With each test, they tell you to blow, blow, blow.
• Some places don’t have this equipment for PFT testing. In that case, you blow into an apparatus. The doctor, nurse, or technician gets a reading from that.
• A CT Scan may also be used.
• Your ankles might be checked more often for edema.
• Bloodwork may be tested more often.
• You may need to use a nebulizer, as well as a rescue inhaler.

Stage 3 COPD: Severe symptoms and increasing flares

Stage 3 is the serious stage. A person might notice an increase in some of the following symptoms at this stage:

• Fatigue
• Chest tightness
• Shortness of breath
• Difficulty catching breath
• Reduced oxygen level
• Wheezing
• Coughing
• Amount of mucus
• Exacerbations/flares

Stage 4 COPD: Late or end-stage COPD

Stage 4 is the final stage of COPD. This is called the end stage. Many don’t like the term end stage, because it sounds like life is over. It isn’t, though. As my dad’s Gastro doctor once told me, “there is no crystal ball”. I know people who have been in Stage 4 for a few years to 20 years. Here is more of what to expect and consider at this stage:

• Decreased oxygen levels
• More shortness of breath
• Increased mucus production
• More coughing
• More fatigue
• Increased exacerbations. They may come on more suddenly.
• There may be more need for oxygen on a regular basis, if not already on it. Oxygen levels need to be below 89% for Medicare.
• Your nebulizer will likely be used more than a few times a day. Possibly at night, according to each person's needs. The rescue inhaler will be used as well.
• If you think about going to the ER, go.

Recognizing and responding to COPD exacerbations

A COPD exacerbation, or flare-up, is a worsening of the COPD symptoms a person experiences. If you feel an exacerbation, you should call your doctor. Take exacerbations seriously, as they can affect and possibly harm your lungs. Your doctor will likely check your oxygen level with a pulse oximeter and your blood pressure. You might have a chest X-ray done and possibly bloodwork. Medications given may include a steroid and an antibiotic. Here are some signs of an exacerbation:

• Decreased oxygen level
• Shortness of breath
• Difficulty breathing
• Increased respirations
• Confusion
• Excess mucus
• Yellow or green sputum. Red sputum may indicate blood (bleeding).
• Bacterial or viral infection
• Wheezing
• More coughing than normal
• Fatigue
• Headaches
• Dizziness
• Edema
• Loss of appetite

The importance of caring for yourself

Here is why caring for yourself is so very important:

• Exercise strengthens your body, muscles, even lungs. It helps to increase your pulmonary function.
• Nutrition is so important. So often with COPD, some people will lose weight. Their bodies are oxygen-starved, yet they work so hard to breathe that they lose weight. They may not feel like eating, so they force themselves. Others are overweight and struggle to lose weight, which can also affect breathing. This can cause shortness of breath and make it harder to breathe. It’s so important to eat healthily.
• Doctor visits are important. Your doctor will monitor your health. He/she will monitor your oxygen levels, heart rate, medications, and weight. They will check your ankles, feet, and arms for edema (fluid). They may press on your upper abdomen to check for fluid or to see if it’s hard. It’s important that you don’t have fluid in your lungs.
• Medications do count. Each is prescribed because of a need. That can be for breathing, allergies, high blood pressure, and more. Medications can be over-the-counter, such as vitamins, antacids, and even for mucus. Remember the herbal types you take too. Your doctor needs to know this to make sure everything you are taking will work together and to make adjustments if necessary.
• Oxygen is a medication - some people might not realize that. If your oxygen runs below 89%, according to Medicare, you qualify for oxygen. Insurance companies usually follow the Medicare standards for oxygen. If this is prescribed for you, use it! It’s important to keep your lungs and other organs healthy.