Signs of COPD Progression

Medically Reviewed By Nick Villalobos, MD

Chronic obstructive pulmonary disease (COPD) involves two lung diseases — emphysema and chronic bronchitis — that inflame your airways, making breathing harder. COPD is progressive, which means that difficulty breathing and other symptoms get severe over time.


How quickly or slowly COPD progresses differs for each person. Some people have few or no symptoms for many years. Others progress very quickly to severe shortness of breath. Smoking, exposure to chemicals or pollution, and lung infections can worsen symptoms more quickly.

Getting familiar with the four stages of COPD and the symptoms of each stage can help you know when it’s time to contact your doctor.

Why COPD progresses

COPD inflames and damages your air sacs — the tiny, balloon-shaped sacs in your lungs that move oxygen into your bloodstream and remove carbon dioxide. The more damage your air sacs experience, the harder it is to breathe. That’s why symptoms like shortness of breath and wheezing increase as COPD progresses.

The 4 stages of COPD

Experts classify COPD stages based on the Global Initiative for Chronic Obstructive Lung Disease, a program of the National Heart, Lung, and Blood Institute and the World Health Organization. Each stage comes with its own set of symptoms and treatments.

Stage 1: Mild

You might not notice anything unusual with your lungs at this first stage. Symptoms that do occur can include cough and increased mucus production.

Treatments: Making a few changes to your daily life, like quitting smoking and avoiding secondhand smoke, may improve your lung function. If you need treatment to manage a cough or other symptoms, your doctor might recommend using a bronchodilator medication to open up your airways in your lungs.

Stage 2: Moderate

Symptoms like a cough and shortness of breath become more noticeable at this stage. It may be hard for you to exercise or walk without losing your breath. This is the stage when people usually realize their health condition and contact a doctor.

Treatments: Your doctor might prescribe a bronchodilator to open up your airways. Steroids or oxygen can help you breathe during a flare. Your doctor might also recommend pulmonary rehabilitation, a program that teaches you how to manage COPD.

Stage 3: Severe

At this point, shortness of breath and cough could be severe enough to interfere with your daily activities. Chest tightness, wheezing, and frequent colds or other infections are also common at the severe stage.

Treatments: Along with the same treatments recommended for stage 2, you may need oxygen to help you breathe.

Stage 4: Very severe

Your oxygen level is very low at this stage. You can be at risk of respiratory failure, which is when your lungs can’t supply enough oxygen to meet your body’s needs. Symptom flare-ups occur more often now, and they can be life threatening.

Treatments: In addition to your current treatment, your doctor might recommend surgery. A bullectomy removes sections of air sacs from your lungs. A lung transplant replaces one lung with a healthy lung from a donor.

Signs of COPD progression

These are some of the signs that your lung function is getting severe and it may be time for additional treatment:

  • Shortness of breath: At first, you might only feel short of breath when you exercise. As COPD progresses, you might get breathless with less effort. You might even wake up from sleep feeling short of breath.
  • Cough: It can get worse over time and bring up mucus.
  • Wheezing: Narrowing in your airways and lung congestion produces this whistling sound when you breathe in or out.
  • Tiredness: Fatigue could make it hard for you to do everyday activities.
  • Infections: You may have more frequent colds and other respiratory infections.
  • Difficulty doing activities: Making the bed, cooking, and doing other daily tasks may get more challenging as your breathing becomes increasingly difficult.

Symptoms like these appear during flares and then improve. The number of flare-ups can increase in the later stages of COPD.

These are a few symptoms that may not start until COPD progresses:

How your doctor measures COPD progression

Increasing symptoms are clues that your COPD is worsening. Tests like these from your doctor can confirm whether your disease is progressing.

  • Spirometry measures the volume and force of air you breathe out to determine how much blockage your airways experience.
  • CT scan is an imaging test that can show how much damage your airways have experienced.
  • A sputum sample tests a small amount of phlegm for signs of inflammation or infection.

Next steps 

Contact your doctor if you have severe symptoms of COPD, like a cough, wheezing, or shortness of breath. You may need a change in treatment to help you breathe better and protect your lungs from experiencing further damage.

You can slow the progression of COPD and preserve your remaining lung function by following your treatment plan, refraining from smoking, and avoiding exposure to harmful chemicals, such as asbestos and silica, and pollutants.

Doctors also recommend getting routine vaccines like the flu and pneumonia to protect against infections that can harm your lungs.

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  1. Agarwal, A. K., et al. (2022). Chronic obstructive pulmonary disease.
  2. Chronic obstructive pulmonary disease (COPD). (2022).
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  4. Overview: Chronic obstructive pulmonary disease (COPD). (2023).
  5. Shaw, J. G., et al. (2014). Biomarkers of progression of chronic obstructive pulmonary disease (COPD).
  6. What is COPD? (2022).

Medical Reviewer: Nick Villalobos, MD
Last Review Date: 2023 Apr 7
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