COPD attacks the lungs in four stages

COPD often begins with a cough before severe lung damage becomes noticeable.

COPD often begins with a cough before severe lung damage becomes noticeable. (Source: AndreyPopov/Getty Images)

The chronic obstructive pulmonary disease COPD permanently damages the lungs and narrows the bronchi.

Chronic obstructive pulmonary disease (COPD) develops over years. At the beginning there is the typical cough, also known as a smoker’s cough. As the disease progresses, breathing difficulties and even shortness of breath occur. It can happen that those affected suffer from shortness of breath at some point, even at rest . Experts differentiate between four stages of COPD.

What is COPD?

COPD develops gradually from chronic bronchitis , i.e. inflammation of the airways First, those affected notice an increasing cough with sputum . Over time, audible breathing noises such as whistling or humming appear, and breathing problems become more common during physical activity – for example when cycling, climbing stairs or shopping. The tissue is damaged due to the ongoing inflammatory processes in the lungs and bronchi . It hardens and scars.

“Smoking is the most significant risk factor for COPD. Although not every smoker gets sick, most of those affected smoke or have smoked in previous years,” says Professor Adrian Gillissen, chief physician at the Medical Clinic III of the Reutlingen district clinics and a member of the German Lung Foundation e . V. “But certain types of dust and gases at work can also irritate the lungs to such an extent that COPD develops. COPD is currently the third most common cause of death worldwide.”

The four levels of COPD severity

COPD often begins unspecifically. What is initially noticeable is a persistent cough, which is often accompanied by sputum. This is due to increasing damage to the cilia due to the existing inflammatory processes. The cilia line the lungs and transport mucus and foreign substances to the outside. If the function of the cilia is restricted, the lungs’ ability to clean themselves is impaired.

Mucus and foreign substances are increasingly carried beyond coughing. Since the respiratory tract is not severely damaged at the beginning of the disease, those affected initially do not notice any further restrictions such as breathing problems. These develop over the years. In most cases, those affected in advanced stages are older than 60 years.

According to the classification of the GOLD Committee (Global Strategy for Prevention Diagnosis and Management of COPD), the lung disease is divided into four stages:

  • Stage 1 (initial stage): Lung function is only slightly restricted. The breathing difficulties are mild in the initial stages. Those affected notice little or no reduction in lung function. Chronic cough with or without sputum, also known as smoker’s cough, is a possible early warning sign. However, this does not occur in all those affected.
  • Stage 2 (moderate COPD): Lung function is moderately impaired. Those affected notice slight shortness of breath during intense physical exertion. Chronic cough with or without increased mucus production is now a common symptom. It is noticeable that the cough does not go away.
  • Stage 3 (severe COPD): Lung function shows moderate narrowing of the airways (airway obstruction). Those affected suffer from intense coughing with thick sputum and severe breathing difficulties. Even light physical activity, such as climbing stairs, causes people with COPD to lose their breath and experience shortness of breath. The heart is under increasing strain as it tries to compensate for the reduced oxygen supply. Water retention often forms in the legs. The risk of harmless infections becoming serious is significantly increased. Therefore, those affected by lung disease should receive vaccinations against pneumococci and influenza viruses.
  • Stage 4 (very severe COPD): Lung function is severely impaired. Some COPD sufferers, especially those with lung overinflation, a so-called pulmonary emphysema, are chronically undersupplied with oxygen and suffer from severe shortness of breath – sometimes even at rest. You are no longer physically resilient. Due to the lack of exercise, physical performance continues to decline, especially if the cardiovascular system is not trained and muscle mass dwindles. An oxygen device or even a ventilator is indispensable when the lungs can no longer absorb enough oxygen and breathe out carbon dioxide. Experts refer to this as chronic respiratory failure. The breathing difficulties can also become life-threatening in the event of an acute deterioration, known as an exacerbation. In the final stages of COPD, right heart damage may develop (cor pulmonale).

In addition to the COPD-related lung function impairment, the symptoms described above and respiratory failure, pulmonologists take into account the frequency of exacerbations (significant worsening of the disease) as well as the symptoms recorded using a questionnaire, such as shortness of breath or limited physical activity. This allows for a finer division into patient risk groups A, B and E, from which concrete instructions for COPD therapy and patient management can be derived.

“COPD does not necessarily have to go through all four stages. With appropriate treatment and prophylaxis, progression can be delayed or even minimized,” says Gillissen. “It is important that those affected avoid risk factors such as smoking and maintain a generally healthy lifestyle with sufficient exercise. Special pulmonary exercise strengthens and supports the function of the lungs. It is also important that the prescribed medication is taken regularly and other medical recommendations are taken into account. Patients Training helps to deal with the disease. Rehabilitation measures aim to maintain and even improve the therapy goals.”

There is no cure for COPD

The earlier COPD therapy is initiated, the easier it is to counteract progression. There is no cure for chronic obstructive pulmonary disease. The goal of therapy is to improve the symptoms. With a good response to therapy, successful quitting of smoking and compliance with further recommendations for lung health, those affected can in most cases regain their quality of life.

“If the lungs have already suffered damage, it cannot be reversed. Treatment as early as possible is therefore important in order to counteract a severe course and improve existing symptoms,” emphasizes the specialist in pulmonology. “As part of the therapy, inflammatory processes, swelling of the airways and mucus formation can be reduced. This makes it easier for those affected to breathe.”

When to go to the doctor if you have a cough?

The expert advises that anyone who suffers from a persistent cough should see a pulmonologist and have the cause clarified. If there is accompanying unexplained shortness of breath, sputum with blood and bouts of fever, this is a clear indication of a serious lung disease. “If COPD is present, the pulmonologist can classify lung function with a pulmonary function test.

The faster the particularly important FEV1 value falls per year, i.e. the forced volume that can be exhaled after maximum inhalation, and the more frequently the COPD exacerbations occur, the worse the long-term prognosis for the person affected,” says Gillissen. “The COPD -Treatment depends on the stage of the disease.”


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