What Happens in the Last Stages of COPD?

Ask a Doctor

My father was a smoker for decades and he refuses to quit, despite his worsening COPD. What happens in the last stages of chronic obstructive pulmonary disorder? How do you die from COPD?

Doctor’s Response

The following may occur as COPD worsens:

  • Intervals between acute periods of worsening of dyspnea (exacerbations) become shorter.
  • Cyanosis (discoloration of the skin) and failure of the right side of the heart may occur.
  • Anorexia and weight loss often develop and suggest a worse prognosis.

Cigarette smoking or exposure to tobacco smoke is the primary cause of COPD. While COPD occurs in 15% of cigarette smokers, tobacco use accounts for as much as 90% of the risk for the development of this disease.

Secondhand smoke or environmental tobacco smoke also increase the risk of respiratory infections and can result in a decrease in lung function.

People with COPD experience a more rapid decline in what is called forced expiratory volume, or FEV. FEV is the maximum volume of air that can be exhaled within a specified time period, starting from maximal inhalation. A subscript indicates the time period in seconds. For example, FEV1 is the maximum volume of air that can be exhaled within 1 second. A decline in FEV causes a person to become short of breath and to have difficulty breathing. It is important to note, that an individual that has a more rapid decline in lung function from tobacco abuse, returns to a normal, slower decline when they quit smoking cigarettes.

For people with mild COPD, the prognosis is favorable. More severe cases of COPD suggest a worse prognosis. Of those people who are admitted to the ICU with an acute exacerbation, the death rate is 24%. This rate doubles for people aged 65 years or older. The predictors of death due to COPD are as follows:

  • Aging
  • Continued smoking
  • Accelerated decline in FEV1
  • Moderate-to-severe airflow obstruction
  • Poor bronchodilator response
  • Severe hypoxemia
  • Presence of hypercapnia (increased arterial carbon dioxide tension)
  • Development of cor pulmonale (right-sided heart failure)
  • Overall poor functional capacity

For more information, read our full medical article on COPD.

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