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The Stages of COPD

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Dear COPD Coach,
After having a spirometry test in September, I visited my doctor a week ago for the results. I am a smoker–but I have cut back from one pack a day to two cigarettes a day. The results of the test were that I have mild to moderate COPD. The doctor prescribed medication and gave me a peak flow meter with instructions to take a reading twice a day.

My doctor told me that there is no cure for COPD, but that I should have no further progression if I do not smoke. I went home and since, have smoked another cigarette. What would be my prognosis for getting to Stage Three? Why would you label the disease as a stage if it can be managed?

Thank you,
—Wanting Answers

Dear Wanting,
First of all, congratulations on being able to quit smoking! That’s a huge first step and often the hardest! Not smoking will not only be better for your breathing, but will also offer a lifetime of benefits to your overall health!

You doctor is right in saying that there is no cure for COPD, but that COPD can be managed. Your ability to slow the progression of your symptoms will depend on several factors. Managing COPD will involve working closely with a pulmonary professional–taking your medications as prescribed and very importantly, learning to recognize the signs of an exacerbation (times when your symptoms get worse) and getting prompt treatment before small symptoms escalate into a full-blown episode or illness (COPD exacerbation).

The importance of exercise in a person with COPD cannot be over emphasized. You should involve yourself in a regular exercise program, preferably designed by a pulmonary rehabilitation expert. By exercising you will train your muscles to work with less oxygen, and as a result you will not get out of breath as easily and will dramatically improve your overall health!

Not smoking is a big step, but it will also entail staying away from secondhand smoke, chemicals fumes, pollution, and dust. All of these can aggravate your breathing and can lead to an exacerbation.

Education plays an important role, and can help you to take control of your life, your symptoms and your health. The more you learn about COPD, the better you will be able to recognize warning signs and adjust your lifestyle accordingly.

Diet is also extremely important in managing COPD. Most people with COPD burn many calories just to breathe, so it is important to get the correct nourishment you require. A good source of information is our Big Fat Reference Guide at This guide contains all the information you will need including how to take medications, understanding test results, diet, exercise, and so much more! Another good source of information is the COPD Digest Magazine. For a free subscription, call our COPD Information Line at 866-316-COPD (2673).

Now to answer your last questions: As with any chronic disease, effects and progression of that disease vary greatly from one person to another. Many factors, such as overall health, co-morbid conditions (other conditions such as heart disease, diabetes, etc.), adherence to prescribed treatment plan, and yes, even mental attitude, come into play.

Having said that, although manageable, COPD will still progress with age. The stages of COPD used to be numbered 1,2,3,4 mild to very severe, and were based on airflow limitation (how much air you can blow out in the first second of a long exhalation, found on a lung function test) alone. The COPD stages have now been updated to better reflect the wide range of limitations in individuals with COPD. These new stages are A,B,C,D and are based on three major factors: Airflow limitation, (how much air you can blow out in the first second of a long exhalation, history of exacerbation (how often you have bad episodes or illness due to COPD), and how you perceive your own limitations in activity and your level of breathlessness.

Again, it is important to understand that the COPD grading system is only meant to be used as a guideline for care, not a life expectancy! There is no time frame as to when you might progress to a different stage or how long you can stay at each stage. Remember you can be in control of COPD by taking extraordinarily good care of your health and managing symptoms as they arise, and in doing so you can greatly influence any progression.

You have begun taking the necessary steps to control and manage your COPD by no longer smoking. This is the beginning of your new journey. Rest assured we will be with you through each step until there is a cure!

Thanks for writing,
The COPD Coach

Ask the Expert is aimed at providing information for individuals with COPD to take to your doctor, and is not in any way intended to be medical advice. If you would like to submit a question to the Coaches Corner email us at We would love to hear your questions and comments. You can address your emails to any of the following: COPD Coach, Caregiver Coach, COPD Doctor or COPD RT.


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  • Thank you for sharing so much to learn on the sight i got major wakeup call when i got out of hospital on sept 28th.3x in hospital from aug 8th sept 10 -13thand sept 21st to sept28 and each time went back to smoking except this last one and now im scared after they told me i had picked up pheumoniahad multiple nodules on my lungs and said late stages of copdand dont know or when i can find out about nodules if they are cancer 50 percent chance is what i read just finished up my last dose of so scared im forcing myself to excersise im on oxegen 24 7 and etc stop smoking i havnt had 1 in 25 days hope it at least helps somewhat good luck ken b
  • COPD is something you can manage and control and it appears you have begun the process of quitting smoking but aren't there yet. This is something you must do. If you continue to smoke, the damage will continue to occur at an accelerated rate and life will continue to get worse. In your shoes, I would see if you can't find a medical professional who specializes in smoking cessation. These folks are specially trained and know how to treat nicotine addiction.

    Once you've quit, eventually, you'll get to the point where you'll still lose lung function every year, just like the non-smoking public, but you won't lose it any faster than they do. The problem is that you're starting with just a percentage of what the non-smoking public has, so you'll always be losing a bit of ground. For instance, my FEV1 is 37% and it has stayed in the mid 30s since 2000 when I was first diagnosed. However, in that time, I have lost function, because it's relative. If I look at the actual liters blown, I have lost the same amount of lung function as someone without lung disease.

    So quit now.

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