Severe COPD

There is not one commonly used definition of severe COPD. Some people might also refer to severe COPD as late-stage COPD.

There are lots of different things that can mean you have a more severe case of COPD, including your level of airflow obstruction and how your symptoms affect you. If you want to know how severe your COPD is overall, it’s best to speak about it with your healthcare professional at your COPD review.

COPD affects different people in different ways. Some people with the condition only have mild lung damage and few symptoms, other people can have very damaged lungs and can find daily life very limited by breathlessness. These people would usually be considered to have a severe case of COPD.

Over time, COPD does get worse because it is a progressive condition. How fast this happens varies from person to person. 

Stages of COPD

The most common use of the term severe COPD is to describe somebody with severe or very severe airflow obstruction.

To diagnose you with COPD, your healthcare professional will use the results of a simple breathing test (spirometry). This measures how much air you can blow out and how quickly. The amount of air you can blow out in one second compared to how much you should be able to blow out is described as the level of airflow obstruction:

The amount of airflow obstruction is only one part of measuring how severe your COPD is. These stages are helpful for your healthcare professional to think about what treatments could work for you, but COPD symptoms are not only linked to how much airflow obstruction you have. 

What else can make COPD severe?

It’s important to consider other things that can make your COPD more severe. These include:

• Smoking. If you smoke, stopping is the best way to prevent your COPD from getting worse and increase your life expectancy.
• How breathless you are. For example, you might get breathless while getting dressed. Healthcare professionals use the Medical Research Council scale to assess how much your breathlessness is affecting you.  
• How much your other symptoms affect you. For example, how much you’re coughing or how much phlegm (sputum) you’re producing. Your healthcare professional should use the COPD Assessment Test (CAT) to see how much your symptoms are affecting you.
• If you’re having frequent COPD flare-ups (exacerbations).
• If you’ve been admitted to hospital because of your COPD.
• If you need to use certain COPD treatments, like oxygen therapy or non-invasive ventilation at home.
• If you have other long-term medical conditions as well as COPD. For example, heart disease or anxiety.
• Your overall level of fitness. For example, if you are not very physically active, or if you are underweight or frail.
• The type of COPD you have. Some people with COPD have mostly got airway disease (chronic bronchitis), some have damage to the lung tissue (emphysema), and many have both. People with emphysema tend to have a worse prognosis. 

People with severe COPD usually have worse symptoms – they are more breathless and more likely to be troubled by cough and sputum. COPD tends to get worse over time, though how quickly that happens varies a lot from person to person.  

You might also get some additional symptoms if your COPD is more severe, including:

• losing weight
• tiredness (fatigue)
• swollen ankles (oedema)
• chest tightness
• coughing up blood. This is a very serious symptom and always requires action. Find out what to do if you cough up blood.

Manage your COPD well

The key things you can do to stop your condition getting worse are: 

• Stop smoking. If you smoke, stopping is the best way to prevent your COPD from getting worse and increase your life expectancy.
• Use a COPD self-management plan.
• Use the best COPD treatments for you and manage your COPD well.
• Check that you’re using your medicines properly. For example, if you use inhalers, check your inhaler technique using our online inhaler technique videos.
• Get any vaccines that you’re offered, including your flu, COVID-19, RSV and pneumococcal vaccines.
• Ask your healthcare professional if you need to see a lung specialist.
• Go to pulmonary rehabilitation (PR) classes.

Use our COPD Patient Passport

Use our COPD Patient Passport to make sure you’re getting the best care for your COPD. 

Our COPD Patient Passport is a best care checklist that asks you a series of short questions about your current COPD care. These questions are based on the latest treatment guidelines. Once you’ve filled it in, you’ll receive a personalised report that can help you improve your COPD care. Share it with your doctor or nurse to make sure that anything missing is sorted out.

With COPD, you might experience flare-ups (exacerbations) of your condition. This is where your breathing and other symptoms get worse suddenly over a short period of time.

Frequent and severe COPD flare-ups can increase your risk of dying. Preventing flare-ups by managing and treating COPD well can increase your life expectancy and improve your quality of life.

Over time, some people may not be able to manage COPD flare-ups at home and may need to go to hospital for treatment. Sadly, severe flare-ups can be fatal. It’s thought that around 1 in 10 people admitted to hospital with a COPD flare-up will die within 90 days. Around 4 in 10 people will need to be readmitted within 90 days of being discharged from hospital.

If you have more severe COPD, it’s important to think about what you would like to happen if your condition gets worse and talk to your healthcare professional about longer-term treatments.

Thinking about the end of your life can be very difficult, but it can be comforting to know that you’re helping your family and the people caring for you to understand your wishes.

Planning for the end of your life is called advanced care planning (ACP). We have more advice about advance care planning and taking control of your choices.