End-Stage COPD: Signs, Symptoms, and Prognosis

COPD is a group of diseases causing an inflammatory reaction and irreversible damage to the lungs.

Chronic obstructive pulmonary disease (COPD) is a group of diseases causing an inflammatory reaction and irreversible damage to the lungs. They cause obstruction of airflow and difficulty breathing. Emphysema and chronic bronchitis are the most common diseases that makeup COPD. It’s a lifelong disease with periods of flare-ups. It negatively impacts the quality of life and longevity.

During inhalation, air travels through the nose and/or mouth into the trachea (windpipe). The trachea further divides into two tubes called bronchi, which opens into the lungs. Within the lungs, the bronchi branch out into smaller tubes called bronchioles. The end of the bronchioles opens into little air sacs called alveoli, which aid in gaseous exchange. The alveoli are surrounded by blood vessels, through which the exchange of gases, oxygen, and carbon dioxide takes place.

Exposure to chronic obstructive pulmonary disease (COPD) triggers leads to the collection of different types of white blood cells and inflammation-causing chemicals in the lungs. This leads to tissue swelling, damage, and increased mucus secretion in the airway and air sacs.

Emphysema is a disease of the alveoli (air sacs). There is irreversible damage to the alveoli, making them less elastic. There is decreased exchange of gases, leading to decreased oxygenation in the body (hypoxia). Eventually, patients have severe breathing difficulties.

Chronic bronchitis is a disease of the bronchus (tubes that enter the lungs). The trachea can also be involved. Inflammation due to irritants causes inflammation, leading to an increase in the number and size of mucus-secreting glands. There is also damage to the cilia (small hair-like structures located in various parts of the body) to help clear mucus. There is decreased clearing of mucus that accumulates and thickens, causing airway obstruction. Long-term inflammation also leads to airway narrowing.

The signs and symptoms and severity depend on the stage of chronic obstructive pulmonary disease (COPD), and they worsen during flare-ups. There are four stages of COPD:

• Stage I: Mild COPD
• Stage II: Moderate COPD
• Stage III: Severe COPD
• Stage IV: Very severe COPD (End stage)

Signs and symptoms of stage I:

Symptoms are mild and often missed, but damage to the lungs begins.

Patients may only present with constant shortness of breath on exertion.

Signs and symptoms of stage II:

Symptoms are more severe than stage I, and there a mild impact on the quality of life. Patients present with

• Persistent cough with mucus, which may be worse in the morning.
• Shortness of breath even with mild routine activity.
• Wheezing on exertion.
• Disturbed sleep.
• Fatigue.

Signs and symptoms of stage III:

Stage III has a bigger impact on the quality of life.

Symptoms in stage III worsen considerably. In addition to that, patients present with

• Frequent respiratory tract infections.
• Swelling of the ankles, feet, and legs.
• Tightness in the chest.
• Trouble taking a deep breath.
• Wheezing and other breathing issues when doing basic tasks.

Signs and symptoms of stage IV (end-stage COPD):
This is the final stage of COPD. This occurs after years of continuous damage to the lungs. Patients have worsened symptoms of stage III and frequent flare-ups that could be fatal. Patients have very poor quality of life.

Patients also present with

• Barrel-shaped chest.
• Constant wheezing.
• Being out of breath.
• Delirium.
• Increased heart rate or heartbeat.
• Loss of appetite and weight.
• Increased blood pressure.

Tobacco smoking: This accounts for 90% of chronic obstructive pulmonary disease (COPD) risk.

Environmental factors:

• Passive smoking
• Indoor cooking with poor ventilation
• Air pollution
• Exposure to chemicals
• Exposure to industrial dust and fumes
• Intravenous drug abuse
• Infections such as human immunodeficiency virus (HIV)
• Genetic disorders such as Marfans syndrome, Alpha1-antitrypsin deficiency, etc.

It is important to talk to your doctor about your treatment options and to get answers to all of your questions.

• Short-term and long-term bronchodilators (inhalers)
• Oral steroids or steroid inhalers
• Medication to clear thin mucus and clear the airway
• Antibiotics
• Quitting smoking and avoiding exposure to other irritants
• Pulmonary rehabilitation 
• Oxygen therapy
• Surgery in severe cases, for example, lung transplant may be required