What are the Four Stages of COPD?

Authored by The Rx Advocates, / Medically Reviewed by Dr. Conor Sheehy, PharmD, BCPS


Many people have heard of COPD. There are many commercials on TV advertising different medications to help people with COPD. What people might not know is that there are four stages of COPD.

What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a group of diseases that cause breathing problems. The two biggest diseases in COPD are emphysema and chronic bronchitis. More than 16 million people in the United States have been diagnosed with COPD.

There is no cure for COPD. Lifestyle changes and medical treatment can slow down the progression of the disease in some cases. Millions of Americans could have COPD but have not been diagnosed.

Stages of COPD

The first stage of COPD is often missed by many people, they do not realize there could be a problem. Once someone moves into stage II they will likely go to a doctor.

The four stages of COPD are:

  • Stage I-Mild COPD
  • Stage II-Moderate COPD
  • Stage III-Severe COPD
  • Stage IV-Very Severe (end-stage) COPD

Stage I COPD

Someone with stage I COPD might not realize they have COPD. The mildest symptom is shortness of breath when doing some activity. Many people might think it is just part of getting older.

A person who has stage I COPD may have lung infections more often than the average person. This includes colds and the flu.

Other symptoms someone might experience include:

  • Wheezing when breathing
  • Shortness of breath with physical activity
  • Tight feeling in the chest
  • Persistent cough that produces mucus

COPD is a disease that worsens over time.


Stage II COPD is considered moderate COPD. Most of the symptoms are the same as stage I, just worse. Additional symptoms can include weight loss, swelling in the feet, blue/gray fingernails, and rapid heartbeat.

Doctors can measure how well a person’s lungs are working by using a spirometry machine. The measurement of air a person can forcefully exhale in one second is called FEV1.

A patient is in stage II COPD if their FEV1 is between 50% and 79% of normal. The severity of symptoms can vary from person to person with stage II.


Stage III COPD is severe, it affects someone’s everyday activities. The FEV1 of someone at stage III COPD is 30-49% of normal. The airflow into and out of the lungs is greatly reduced.

The symptoms of stage III COPD include:

  • Wheezing.
  • Tight feeling in the chest.
  • Coughing that brings up mucus.
  • Extreme shortness of breath.
  • Swelling in the feet, ankles, or legs.
  • Loss of muscle strength.
  • Fatigue.

People at stage III COPD could develop more lung infections and could have to be hospitalized at times.


Stage IV COPD is sometimes called End-Stage COPD. At stage IV a person’s FEV1 levels are below 30% of normal. This stage has severe shortness of breath, even when resting.

Additional symptoms of stage IV COPD include:

  • Chest pain.
  • Fatigue.
  • Bacterial infections.
  • Severe shortness of breath.
  • Coughing up blood.
  • Swelling in the feet, ankles, legs.
  • Pulmonary hypertension (high blood pressure in the pulmonary artery of the lungs).
  • Weight loss.
  • Fast heartbeat.

COPD Group Classifications

In addition to the stages of COPD, there are groups that classify the level of symptoms. The groups are A, B, C, or D.

The groups are defined by how bad symptoms are, and by how many exacerbations happen. A COPD exacerbation is when symptoms are noticeably worse for some time.

Groups A and B are people who have had no exacerbations in the past year or one exacerbation they did not need to be hospitalized for. Group A is minimal to mild breathing issues, group B is more serious breathing issues.

Groups C and D include people who have had to be hospitalized for an exacerbation in the past year. It also includes people who have had multiple exacerbations they were not hospitalized for. Group C has milder symptoms, group D has more serious symptoms.

Stage IV D is the most serious diagnosis of COPD.

What Causes COPD?

The usual cause of COPD is long-term exposure to things that create lung damage. In the United States 75% of people with COPD smoke, or used to smoke.

Other things that can cause lung damage leading to COPD include:

  • Air pollution
  • Secondhand smoke
  • Chemical fumes or dust in the workplace

In rare cases, a genetic condition called alpha-1 antitrypsin deficiency can contribute to COPD. People with this genetic condition have low levels of the alpha-1 antitrypsin protein. The low protein levels increase the risk of lung damage when exposed to lung irritants.

Treatment Options for COPD

There is no cure for COPD. In 2020, chronic lower respiratory diseases were the sixth leading cause of death in the United States. This includes asthma and COPD.

Lifestyle changes can help slow down the progression of COPD. One of the most important things for a person to do is quit smoking if they have not yet.

Joining a pulmonary rehabilitation program can help. This is a group class that educates on lung diseases. The class includes exercise, so people can learn how to exercise with fewer breathing problems.

Medication for COPD

There are many kinds of medications that can help control symptoms of COPD.

Bronchodilators relax the muscles around the airways to make breathing easier. They usually come as an inhaler. Some are short-acting, some are long-acting.

An inhaled steroid like Flovent HFA can reduce airway inflammation.

Combinations of steroids and bronchodilators are also available:

There are also combination inhalers that have multiple bronchodilators:


In severe cases where medications are not enough, surgery may be an option.

Lung volume reduction surgery is an option for some people. A surgeon removes small sections of damaged lung tissue from the upper lungs. This gives more space for healthy tissue in the lungs to work effectively.

An endoscopic lung volume reduction is another option. This minimally invasive procedure puts a tiny valve into the lung to shrink the most damaged lobe. This allows the healthier part of the lung to function better.

A bullectomy removes bullae from the lungs that form when alveoli are destroyed. Removing bullae improves airflow in the lungs.

In some cases, a lung transplant could be an option.

Get Help Paying for COPD Medications

When someone needs medication for COPD, they will need it for the rest of their life. As COPD progresses over time some people may need to add medications.

Prescription medications are expensive. The Rx Advocates can help.

At The Rx Advocates, we connect people with patient assistance programs. These programs are provided by pharmaceutical companies that make prescription medications. People who qualify do not have to pay for their medications.

These programs can be difficult to get into. The paperwork can be confusing for many people, and they give up. The Rx Advocates will handle all of the paperwork and continue to work with the patient assistance programs on your behalf for one low monthly fee.

Help with one prescription medication is $80 per month, lower than many copays. We can also help with multiple medications. Please contact us today to start saving money on the COPD medications you need.

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Medical News Today. What did the Term ‘stage 4 COPD’ Previously Refer to? https://www.medicalnewstoday.com/articles/stage-4-copd#general-symptoms. June 29, 2021.

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American Lung Association. The Basics of Pulmonary Rehabilitation. https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/pulmonary-rehab. July 13, 2020.

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Medical News Today. What to Know About Bullectomy. https://www.medicalnewstoday.com/articles/325469. June 14, 2019.

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