Emphysema is staged by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (GOLD) system into four levels based on lung function (FEV1) and symptoms: Stage 1 (Mild) (FEV1 ≥80%), Stage 2 (Moderate) (FEV1 50-79%), Stage 3 (Severe) (FEV1 30-49%), and Stage 4 (Very Severe) (FEV1 <30%), with symptoms worsening from mild shortness of breath to severe breathing difficulty and potential life-threatening complications in Stage 4.
One widely used guideline is called the Global Initiative for Chronic Obstructive Lung Disease (GOLD). It's a formula that ranks emphysema in four stages, with 4 being the most serious. Doctors use it as one of many ways to measure your emphysema. A machine called a spirometer tests your breathing for the GOLD stages.
Stage 4 emphysema is the final and most severe stage of the disease, in which a person may experience low blood oxygen levels due to advanced lung damage. Low blood oxygen levels can lead to chronic fatigue and an overall reduction in quality of life.
End-stage emphysema, or stage 4 emphysema, can mean living with a decade or more of breathing problems, tiredness, heart problems or other health concerns that impact your ability to live your life to your fullest.
Symptoms of End-Stage COPD
Many of the symptoms you had in earlier stages, like coughing, mucus, shortness of breath, and tiredness, are likely to get worse. Just breathing takes a lot of effort. You might feel out of breath without doing much of anything.
Common signs of COPD exacerbation or flare up:
NUCALA is an add-on, prescription maintenance treatment of eosinophilic chronic obstructive pulmonary disease (COPD) in adults whose disease is not controlled. NUCALA is not used to treat sudden breathing problems.
Sometimes, emphysema can be more severe than COPD with chronic bronchitis, but other times the chronic bronchitis form of the disease can cause worse symptoms than emphysema.
National Emphysema Foundation (NEF)
The good news is that doing some sort of cardiovascular exercise a few times a week can reduce the effects of hyperexpanded lungs. Walking is a healthy, low-impact way to improve lung function.
HOW FAST DOES EMPHYSEMA PROGRESS? Emphysema usually progresses slowly and the majority of patients do not notice the changes in their breathing. Some patients do experience a faster onset of symptoms, though that is less common.
Treatment for emphysema
Starting Your Day With COPD
A shower can be easier to navigate than a bath. Make sure air circulates in your bathroom to remove steam, which will ease your breathing. If shower spray on your face worsens your symptoms, lower the showerhead. Sit down to wash.
Between 88% and 92% oxygen level is considered safe for someone with moderate to severe COPD. Oxygen levels below 88% become dangerous, and you should ring your doctor if it drops below that. If oxygen levels dip to 84% or below, go to the hospital.
A CT scan gives much greater detail of changes in your lungs than a chest X-ray does. A CT scan of your lungs can show emphysema. It also can help in deciding if you might benefit from surgery. A CT scan can be used to check for lung cancer too.
Symptoms
Foods COPD Patients Should Avoid
Pursed Lip Breathing
This exercise reduces the number of breaths you take and keeps your airways open longer. More air is able to flow in and out of your lungs so you can be more physically active.
Walking is an effective low-impact workout, whether you're outside or on a treadmill. Treadmill and outdoor walking offer similar health benefits when the effort is the same. Two 15-minute walks can be just as effective as one 30-minute walk. Walking longer may be better than running shorter for many people.
Researchers have found that for people with COPD, the ideal temperature is 70 degrees with a humidity level of 40%. Temperatures above 90°F (32°C) can be particularly dangerous for people with COPD. You can avoid COPD exacerbations by staying indoors with air conditioning during the hottest times of the day.
Most cases of emphysema are caused by smoking or other environmental factors. There is growing evidence that genetics can also increase the risk of developing emphysema. In about one out of every 50 cases of emphysema, there is a specific hereditary basis for developing disease at an earlier age.
Weight loss, which is common in patients with advanced emphysema, can be caused by inadequate food intake in individuals too short of breath to eat. However, most weight loss in COPD patients is due to the increased metabolic demand of respiratory muscles that are overworked because of emphysema damage.
Advair is one of the most commonly used inhalers for the maintenance treatment of COPD. It is a combination of fluticasone, a corticosteroid, and salmeterol, a long-acting bronchodilator. Advair is used on a regular basis for the maintenance treatment of COPD and it is typically taken twice per day.
FDA approves GSK's Nucala in 2025
This made the drug only the second biologic approved for the lung disease, and the third new COPD therapy to gain approval in the U.S. in less than a year. Nucala is a monoclonal antibody that targets and binds to interleukin-5 (IL-5), a key messenger protein in type 2 inflammation.
TRELEGY is proven to help prevent exacerbations vs an ICS/LABA and vs a LAMA/LABA. TRELEGY significantly reduced the annual rate of moderate to severe exacerbations by 15% vs BREO (P<0.001) and by 25% vs ANORO (P<0.001).