This stage is often referred to as the final or the end stage of COPD. The disease has progressed to an ultimate level beyond which there is no further room for worsening.
The airflow limitation has worsened to the point that chronic respiratory failure sets in. FEV1 falls below 30%. You become breathless even doing your daily household chores like wearing your pants. You will need supplementary oxygen to breathe. Quality of life significantly deteriorates.
Coughing frequency and severity increases, sleep is compromised and edema can set in with swelling of the ankles and feet due to poor circulation of the blood.
Respiratory failure can cause complications that affect the heart such as cor pulmonale. This can be fatal.
The severity and the frequency of exacerbations (flare up of symptoms) increase to the point of being life threatening.
Symptoms of exacerbations include a rapid heart rate, cough accompanied by excessive mucus production that can be yellow or green or bloody, a feeling of tightening in the chest, wheezing and shortness of breath at rest, which worsens on exertion. Medicines may not give relief.
More than half of the patients who have advanced to stage 4 with FEV1 below 30% will not live beyond four years.
While people in stage 4 can be very sick, you will find quite a few who still enjoy an active and quality life. They are the ones who eat right, exercise regularly, take their medications religiously and generally take very good care of themselves.
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