Advanced COPD is a worsening of airflow even with treatment. It causes exhaustion and shortness of breath with basic tasks and even at rest.


Damage to the lungs can increase over time. The damaged tissue make it harder for oxygen to move into the blood. It also takes extra work to push air out of the lungs. It is often part of normal COPD progress.

Risk Factors

COPD will get worse over time. Factors that may speed lung damage include:

  • Problems with treatment plan
  • Smoking
  • Second hand smoke
  • Related medical conditions such as heart disease


Advanced COPD can cause:

  • Increased shortness of breath
  • Choking sensation when lying flat
  • Fatigue
  • Trouble staying focused
  • Weight loss
  • Breathing through pursed lips
  • Urge to lean forward to improve breathing


You will be asked about your symptoms and history of COPD. Breathing tests will be done to measure how much air your lungs can move. Advanced COPD may be diagnosed based on symptoms and results of breathing tests.

Your doctor may look for infections or other conditions that can make breathing worse. Symptoms may improve once infection has passed. Blood tests and x-rays of the chest may be done.


COPD care will be continued. It includes medicine and oxygen therapry. Doses or use may be changed to ease some shortness of breath.

Other care options include:

Ease Breathing

The environment can have a large inpact on ability to breathe. Factors that may play a role include:

  • Extreme heat and cold can make breathing worse. Air conditioning and safe heating options can help.
  • Air quality warnings should be followed. Areas with air contaminants such as chemicals or smoke will also need to e avoided.
  • Smoking should be stopped. Second hand smoke can also cause worsening of symptoms.
  • Fans can ease breathing.

A change in habits can help to conserve energy. It will ease the demand on your lungs. It may also lower fatigue. An occupational therapist can make a plan to decrease workload of erveryday tasks. Some steps may include planning ahead for tasks. Devices may also be needed to ease certain tasks or walking.


Unintended weight loss is a common problem with advanced COPD. The body has to work harder to breathe. It can also be harder to eat with breathing problems. Calorie dense soups or liquids may be recommended. A dietitian may be needed to help meet food goals.


Certain surgeries or procedures may help the lungs work better. They are not appropriate for everyone. Options include:

  • Lung volume reduction surgery—section of lung is removed. This will let other areas expand more.
  • Bronchoscopic lung reduction—procedures to block off areas of the lung.
  • A lung transplant will replace damaged lungs with donor lungs. It will require a lifetime of medicine to keep the body from rejecting the lungs. It is not an option for everyone.

Care Decisions

Palliative care supports people with serious illness. They may provide treatment to improve quality of life. For example, pain and anxiety medicine may help those with regular shortness of breath.

Advanced directives are legal and medical documents that state patient wishes. It will help a medical team and loved ones make decisions if the patient is unabale. A palliative team can help with this process. They can also help to make sure other treatment choices are in line with patient goals.

Hospice care may be needed. The hospice care team specializes in easing pain and suffering from severe end-stage COPD. It may be provided at home or in a care center.


Advanced COPD cannot always be prevented once the disease has begun. Following a care plan and healthy habits can delay it.


American Lung Association

Centers for Disease Control and Prevention


College of Family Physicians of Canada

Health Canada


COPD. EBSCO DynaMed website. Available at: Updated June 11, 2019. Accessed May 1, 2019.

COPD. National Heart, Lung, and Blood Institute website. Available at: Accessed June 19, 2019.

Palliative and Hospice Care. National Institue on Aging website. Available at: Accessed June 19, 2019.

Last reviewed June 2019 by EBSCO Medical Review Board  Last Updated: 6/19/2019