Chronic obstructive pulmonary disease (COPD) is a category of conditions that includes emphysema and chronic bronchitis. It is a progressive condition that gets steadily worse. Over time, the body becomes less able to take in enough oxygen. This can ultimately result in death.
According to the Centers for Disease Control and Prevention, chronic lower respiratory diseases — of which COPD is the most prevalent — were the sixth leading cause of death in the United States in 2022.
Recognizing the end stage symptoms of COPD can help a person cope and say goodbye to loved ones, make peace with their life, seek hospice care, and discuss their final plans.
In this article, we cover the signs and symptoms that may indicate that a person is nearing the end of their life. We also discuss how to help people feel calmer and more comfortable during this stage of their life.
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COPD is terminal. People with COPD who do not die from another condition will usually die from COPD.
Until 2011, the Global Initiative for Obstructive Lung Disease assessed the severity and stage of COPD using only forced expiratory volume in 1 second (FEV1).
FEV1 is a measure of how much air a person can exhale in a single breath. When it falls below 30% of the normal amount, a person may be in the end stages of COPD.
The new standard also looks at shortness of breath, as well as a person’s history of acute COPD episodes, the impact of COPD on their life, and other factors.
The stages of COPD are as follows:
- Mild, or stage 1: FEV1 is above 80%. A person’s symptoms are mild, and they might not even notice that they have the condition.
- Moderate, or stage 2: FEV1 is 50–80%. A person may notice a chronic cough, excess mucus, and shortness of breath.
- Severe, or stage 3: FEV1 is 30–50%. A person may have a chronic cough and struggle to exercise or do daily activities. They may also feel tired or sick.
- End stage, or stage 4: FEV1 falls below 30%. This is the final stage of COPD, and it will severely affect a person’s daily life.
There are two ways to measure end stage COPD. Clinical symptoms are those that testing at a doctor’s office can reveal.
These symptoms can include:
- low blood oxygen, or hypoxemia
- hypoxia, or low oxygen in the body’s tissues
- cyanosis, a bluish hue to the skin due to oxygen deprivation
- chronic respiratory failure, which occurs when the respiratory system cannot take in enough oxygen or release enough carbon dioxide
During late-stage COPD, a person tends to experience more severe flare-ups. They may need to stay in the hospital during these flare-ups. Although a person will get a little better between flare-ups, they tend not to return to their previous condition.
Therefore, a person’s health becomes steadily worse with each flare-up, and each flare-up tends to be worse than the last.
Some other symptoms a person might notice in late-stage COPD include:
- severe limitations in physical activities, including difficulty walking
- shortness of breath
- frequent lung infections
- difficulty eating
- weight loss
- confusion or memory loss due to oxygen deprivation
- fatigue and increased sleepiness
- frequent, severe flare-ups
- more frequent trips to the hospital
- longer hospital stays
- anxiety or depression
- changes in consciousness
- trouble swallowing
- twitching or muscle weakness
- changes in the way a person breathes, or their pattern of breaths
- increasingly loud breathing
Although COPD is terminal, people may not always die of the condition directly, or of oxygen deprivation.
Some people with COPD have other medical conditions, particularly cardiovascular disease. In fact, within 5 years of diagnosis, COPD is also an independent risk factor for sudden cardiac death.
Many treatment options are available to help a person with end stage COPD cope with the pain and discomfort associated with the condition.
Although supplemental oxygen and COPD medications may help, they may not be as helpful as they were in the earlier stages.
Palliative care helps with pain and distress. However, will not treat the underlying condition.
Some palliative care options include:
- help with daily activities, such as getting dressed
- medications to relieve pain
- blowing air into the face to help with breathlessness
- medication for anxiety, depression, or insomnia
- mind-body therapies, such as yoga
- complementary remedies, such as massage therapy
Many people with terminal conditions find significant help from hospice care. Hospices provide end-of-life care that focuses on helping the person feel comfortable, easing their discomfort, and supporting them to make peace with death.
Hospice providers prioritize the well-being of the patient and their desire for a good death, rather than preserving life at all costs.
For some people, anxiety about death is more painful than the physical discomfort of COPD. A person might worry about their legacy or their family, about spiritual matters, or whether they have lived a good life.
Some strategies that may help include:
- Talking about emotions: It is normal to feel angry, afraid, or both. Discussing these emotions may help the person feel some relief.
- Discussing life or wishes with loved ones: People can talk with their family about the legacy they want to leave, the lessons they want to share, and the love they hope to leave behind.
- Talking to people who have experience with death: Hospice providers, religious leaders, and others who have watched many people die may have a different perspective on death than family and friends. People can try talking through their emotions with them.
- Religious rituals: If a person is religious, they can consider talking to a religious leader about end-of-life rituals. Spiritual leaders can offer insight and advice, and they may share their perspective on spiritual matters.
- Getting affairs in order: If possible, people with end stage COPD should ensure that their will is up-to-date. If they hope to leave something to their loved ones, they should make sure the relevant people know this. If the person has young children, they may want to appoint a guardian.
- Support groups and therapy: The emotions associated with being near the end of life can be overwhelming and too significant to process by oneself. People can try seeking the help of a therapist who specializes in such situations. Support groups for terminal conditions may also help.
End stage COPD can be overwhelming. Seeking appropriate palliative care can help with the physical discomfort of COPD.
It is normal for people to feel afraid or angry, and those who are close to death should not feel ashamed of these emotions.
A compassionate medical team and supportive hospice care can help a person feel comfortable and comforted during this stage of their life.
Read this article in Spanish.
Last medically reviewed on June 28, 2022
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Chronic obstructive pulmonary disease (COPD) is a chronic disease that is often preventable and treatable. If you or a loved one has COPD, there are steps to take to cope with the lifestyle changes this disease brings. Learning about COPD and its treatment can help you feel more in control.
Key Points
- COPD is chronic. In other words, you live with it every day.
- It can cause serious long-term disability and early death.
- There is no cure for COPD, but it is often preventable and treatable.
- COPD is referred to as chronic bronchitis or emphysema.
What Is COPD?
With COPD, the airways in your lungs become inflamed and thicken, and the tissue where oxygen is exchanged is destroyed. The flow of air in and out of your lungs decreases. When that happens, less oxygen gets into your body tissues, and it becomes harder to get rid of the waste gas carbon dioxide. As the disease gets worse, shortness of breath makes it harder to remain active.
Sometimes referred to as either chronic bronchitis or emphysema, most people will have symptoms of both conditions, so health professionals prefer to call the disease COPD. However, some doctors think that chronic bronchitis may be present even though a person does not have the airway obstruction characteristic of COPD. Your doctor can explain your condition and the best way to treat it.
It is important to remember that in many cases, COPD can be prevented and can be treated.
COPD is a leading cause of disability and death in the United States. More than 12.5 million people have been diagnosed with COPD, but millions more may have the disease without even knowing it. COPD causes serious long-term disability and early death. At this time there is no cure, and the number of people dying from COPD is growing.
COPD in Women
Deaths resulting from COPD in women are higher than in men. There are a few reasons why this happens.
- In the late 1960s, the tobacco industry intensely targeted women. This resulted in a huge increase in women smoking. We are still seeing new cases of smoking related diseases, including COPD, as women age.
- Women are more vulnerable than men to lung damage from cigarette smoke and other pollutants. Their lungs are smaller and estrogen may play a role in worsening lung disease.
- Women are often misdiagnosed. Because COPD has long been thought of as a man’s disease, many doctors still do not expect to see it in women and miss the proper diagnosis.
COPD is often not found until the disease is very advanced because people do not know the early warning signs. Sometimes people think they are short of breath or less able to take part in their normal activities because they are "just getting older."
It Can Be Treated
There's no cure for COPD, but the good news is that it can be found early. Much can be done to treat and help manage the disease. Through medications, oxygen therapy, pulmonary rehabilitation and social support, many people are able to live with their disease for many years.
Next: COPD Causes and Risk Factors