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Stages of COPD and its progression

There are different stages of COPD or chronic obstructive pulmonary disease. It goes through stages 1-4. In this regard, Dr. Hari Kishan Gonuguntla, Consultant Interventional Pulmonologist at Yashoda Hospitals Hyderabad, said, “Early detection of COPD is important to slow the progression of the disease and avoid serious complications. There are four different stages of COPD: mild, moderate, severe, and very severe. This is evaluated using a spirometry test, which checks the patient’s lung function by measuring how much air you can take in and how quickly and easily you can exhale.”

COPD stages and their progression

Dr. Hari Kishan Gonuguntla said the following:

  • In stage 1 or mild COPD, the main symptoms are mild shortness of breath and a cough with or without sputum. These stage 1 COPD symptoms can be easily ignored and mistaken for symptoms of another disease.
  • Without proper treatment and smoking cessation, lung damage will continue and progress to stage 2/moderate COPD. In moderate COPD, airflow is reduced and symptoms increase. Shortness of breath is more noticeable during physical activities and, coughing and mucus production may increase. In addition to smoking cessation and medicinal treatment, pulmonary rehabilitation is important at this stage to relieve symptoms.
  • Once at stage 3 or severe COPD, lung function decreases significantly. The patient’s lungs will continue to weaken and there will be abnormalities in gas exchange. The previous symptoms mentioned above are more intense and worse. Additionally, the patient may experience extreme fatigue, chest tightness, and frequent respiratory infections. The patient may also experience greater COPD exacerbations. This exacerbation is the leading cause of COPD-related hospitalization.
  • The final stage is Stage 4 or very severe COPD where lung function is severely affected and symptoms are visible even at rest. Some patients may require long-term oxygen treatment even at home to maintain oxygen saturation. More often the intensity may increase and death may occur.

It is important to stop smoking at all stages of COPD to prevent further damage to the lungs. Up-to-date vaccination for influenza and pneumococcal vaccines is also important to prevent and reduce respiratory infections that can cause serious conditions.

Different stages of COPD and how to treat them

“All these stages depend on the severity, which means mild, moderate, severe and very severe. Mild means you don’t know,” said Dr Kuldeep Kumar Grover, head of critical care and pulmonology at CK Birla Hospital, Gurugram. This is COPD, so a mild cough has started. Mild COPD is easily treated with over-the-counter medication. They continue to have whatever symptoms they have, so there are four stages: mild, moderate, severe and Very severe. The second thing is if it is controlled then it is controlled COPD, if it is acute then COPD means uncontrolled COPD just thick medicine.”

Additionally, Dr. Ravindra M Mehta, senior consultant in pulmonology at Apollo Hospitals, Jayanagar, Bangalore, noted the following:

Stage 1 is early COPD and 4 is severe COPD with lung function less than 25-30%. Treatment of COPD depends on what stage it is in. Typically, you try to treat two basic aspects of the patient’s problems.

  • One is the symptoms – What are the symptoms: Is the patient having trouble breathing? Are they coughing a lot? Are they bringing up a lot of phlegm? Are they getting troubled by all these things again and again?
  • The second issue we are trying to address is what is called intensity attacks or technically intensity. So, in stage 1 or early stage COPD, it usually has no symptoms. Patients are given bronchodilators or medicines to open the airways wider. But as the stages progress and inhalers start coming in regularly and often combination inhalers are used. And in the last stage of COPD, maximum inhalers, nebulizers etc. can be used.

“Other things that are very important and probably not more important than the medication is the use of rehabilitation or pulmonary rehabilitation which is a graded exercise regimen over 12-24 sessions that is done under the supervision of a specialist. This exercise “Helps improve their lungs and muscles and make them more functional. It is recommended in COPD stages 2-4,” he said.

Talking further he said, “Other important things are preventive aspects like non-invasive ventilation, oxygen therapy and vaccination. In some COPD patients, procedures like bronchoscopic or Rarely are surgical procedures offered. Finally, in severely advanced, end-stage COPD (also known as lung failure), lung transplantation may be an option.”

Management for all patients with COPD:

Dr Supreet Batra, who is HOD and senior consultant interventional pulmonologist, allergy and sleep specialist at Batra Hospital, listed the following:

non medicinal

  • stop smoking
  • avoid unhealthy air
  • regular physical activity
  • Get your vaccination (flu and pneumonia)
  • Eat healthy food (high protein and low carbohydrates)

Pharmacological Management (Step Wise)

  • Bronchodilators – These medications relax the muscles in your airways and make your breathing easier. They can be short-acting (SABASAMA) or long-acting (LABALAMA) and are available in 3 forms – inhalers (combination inhalers), roracaps, respules for nebulization.
  • Inhaled corticosteroids (ICS) – These medications reduce inflammation and swelling in your airways and are given in combination with bronchodilators for patients with frequent hospitalizations.
  • Combination inhalers – These are now the standard of care with a combination of the above medications.
  • Oral steroids – use in hospitalized patients with severe seizures
  • Phosphodiesterase-4 inhibitors/theophylline/mucolytic/antioxidant agents – add to medications used in patients with multiple attacks
  • Antibiotics – use only during infection

(Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is for general informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified person regarding any medical condition. healthcare provider for any questions you may have regarding.)

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