End-stage chronic obstructive pulmonary disease (COPD) is the last stage of the disease. At this stage, you can expect significant shortness of breath even while resting. Due to the degree of lung damage at this stage, you are at high risk for lung infections and respiratory failure.
You may associate the term "terminal stage" with certain death or serious disability resulting in death. Of course, there is an increased risk of death at this stage, but you can live for years with end-stage COPD.
In the advanced stages of COPD, symptoms can be constant or almost constant. And the consequences of your disease in the end stage will be so severe that they will undoubtedly affect your daily activities.
Symptoms that can occur with end-stage COPD include :
- Chronic cough and sputum production.
- Severe shortness of breath even at rest
- Difficulty eating
- Difficulty communicating due to shortness of breath.
- Limited mobility
- Confusion or dizziness
- Trouble sleeping
You are more likely to have a low oxygen saturation and will likely be prescribed supplemental oxygen. If you stop taking oxygen supplements, you may notice a worsening of your symptoms.
You can develop complications from lung diseases such as pneumonia, heart failure , and lower extremity edema (leg edema). In end-stage COPD, you likely have limited activity levels, putting you at risk for blood clots , obesity, and pressure ulcers .
By definition, "terminal stage" refers to the last phase of a progressive disease. There are criteria that help define this stage.
According to the Global Initiative on Obstructive Lung Disease (GOLD), there are four stages of COPD :
- Stage I: mild COPD. Lung function begins to decline, but you may not notice it.
- Stage II: moderate COPD. Symptoms progress and dyspnea develops on exertion.
- Stage III: severe COPD. Dyspnea worsens and exacerbations of COPD are common.
- Stage IV: very severe COPD. The quality of life is seriously affected. An exacerbation of COPD can be life-threatening .
Each stage is determined according to the spirometric measurement of FEV1 (expiratory volume in the first second after forced expiration). End-stage COPD is considered stage IV or very severe COPD with an FEV1 less than or equal to 30% .
Life expectancy in COPD is influenced by a number of factors , including smoking history, level of dyspnea (shortness of breath), physical condition, and nutritional status. Some people in stage IV can still function normally with some limitations. On the other hand, there are also many people at this stage who are very sick.
You may be concerned that your healthcare providers have done everything possible for you by the time you are diagnosed with end-stage COPD. But there may be aspects of your health that you can manage to help you feel more comfortable and avoid complications from a lung condition.
However, if you have been diagnosed with end-stage COPD, your doctor may prescribe the following treatments:
The updated 2020 guidelines recommend that people with moderate to severe COPD who experience shortness of breath and / or exercise intolerance receive a combination of two different types of long-acting bronchodilators , rather than just one long-acting bronchodilator. This includes long-acting beta agonist drugs (LABA) and long-acting muscarinic / anticholinergic antagonists (LAMA). Some combination inhalers include both categories of drugs in one inhaler. Short-acting bronchodilators can also be used for symptoms .
In the past, opioids were often avoided because some studies have shown that they can have serious side effects and may not benefit everyone. However, the most recent guidelines recommend the use of opioids for people who still have severe shortness of breath despite other treatments. This recommendation comes from research showing that these medications were helpful in improving quality of life, but did not increase the risk of falls / accidents or overdoses .
Glucocorticoids (or "steroids") can be used by inhalation or orally or intravenously, and the instructions for their use have recently changed.
Oral glucocorticoids (such as prednisone) were once widely prescribed, but generally should be avoided on an ongoing basis (they may be needed during exacerbations or during hospitalization). These medications have not been found to affect shortness of breath, flare-up risk, or survival, but they cause a number of side effects, including high blood pressure, high blood sugar, infections, and gastrointestinal bleeding.
Inhaled glucocorticoids may or may not be recommended. While they reduce the risk of flare-ups, they also increase the risk of pneumonia. They are likely to be helpful for people who also have asthma or who have one or more exacerbations of COPD each year. If a person has not had a COPD exacerbation for a year and does not have asthma or an elevated eosinophil count , it is recommended to stop taking inhaled glucocorticoids .
Oxygen reduces shortness of breath caused by activity and rest. Not only can this improve symptoms, but oxygen can allow some people to do other activities (such as rehabilitation and physical activity) that also improve their quality of life.
Non-invasive positive pressure ventilation (NIPPV)
Non-invasive ventilation can reduce carbon dioxide retention and reduce shortness of breath, but is generally not recommended.
Pulmonary rehabilitation has been found to be effective for people with COPD at all stages of the disease. A 2017 study found that in people with severe COPD, pulmonary rehabilitation improved symptoms in 92% of participants and led to a 54% decrease in days spent in the hospital .
Nutritional counseling can be offered because malnutrition is a common complication of end-stage COPD and increases the risk of death. A COPD care consultant can also give you tips to make eating easier and more enjoyable when you're short of breath.
Complementary and alternative therapies, such as relaxation and visualization techniques, therapeutic massage, and music therapy with live instruments, CDs, or radio, can help relieve symptoms such as shortness of breath.
Living with end-stage COPD can make you feel scared and isolated. Receive psychological and social support are important aspects of the fight against this disease.
Even if you already have COPD in a very advanced stage, there are several lifestyle changes you can make to get the best results:
- Quitting smoking: Quitting smoking is vital because smoking continues to cause changes in the lungs in the later stages of COPD.
- Exercise: Also, if you're going to make the one lifestyle change after your COPD diagnosis that will have the biggest impact on your life, consider a daily exercise program. Even a light walk (with oxygen) several times a week can help prevent complications and improve your mood.
- Eat healthy foods – Good nutrition is very important because COPD forces your body to consume a lot of calories and can lead to malnutrition. Eating a proper diet will give you the energy you need to breathe and fight infection.
- Stay positive: Staying positive even when a chronic illness is diagnosed can be difficult, but it can have a big impact. It's about developing new coping mechanisms that fit your lifestyle.
- Review your medications frequently with your healthcare provider: Getting the optimal combination of medications can do a lot to maintain or even improve your quality of life. However, research is ongoing and recommendations for the most effective treatments may change. Frequently reviewing your medications with your doctor can ensure that you are receiving the most up-to-date and effective treatments.
Problems at the end of life
If your healthcare providers have looked at the likelihood of near death from your COPD, it's time to think about how you will deal with problems at the end of your life. Whether you make the decisions at this stage, you or your loved one, deciding how you will seek help at the end of your life can make the process a little easier for everyone involved. For example, you and your family might consider enlisting the help of hospice to guide you through this time.
If you are diagnosed with COPD at an advanced stage, be sure to talk with your healthcare provider and loved ones about your values and beliefs to ensure that any end-of-life care meets your wishes. For resources to help plan end-of-life patient care, see the National Health Decision Day website .
The expanded guidelines are documents that allow you to explain your wishes for end-of-life care so that your loved ones will know what you want in terms of resuscitation, feeding tubes, and respiratory support if you are unable to express your wishes. later.
Symptoms are one of the most important aspects of end-of-life care, as COPD symptoms often worsen in the last few days, especially with shortness of breath and cough , pain, anxiety and depression, confusion, anorexia and cachexia .
The end of life is a time of sadness and deep reflection for you and your loved ones. Remember that simple gestures, like holding a loved one by the hand and being there, can be very comfortable.
Get the word of drug information
Understanding end-stage COPD and what you can do to prevent it starts with taking small daily steps to improve your health. Work with your care team to develop a plan for healthy lifestyle changes, such as quitting smoking, eating whole grains, and, if possible, getting light exercise.
If you have been diagnosed with terminal COPD, it is important to know that it is impossible to accurately predict how long you will live. Making a decision about your health requires weighing the value of comfort and the expected benefits of each type of treatment. The people you love can help you get through these tough times.