what are the last stages and be specific please?

[uncleaj]

i have a family member with copd, he is in an assisted living home thinking he is going to come home when hislegs gets stronger..the nurse there says he's not,, he is still smoking and trying to strengten his legs,,the nurse says the more he exerts himself he's putting more strain on his heart and doing more damage than good,,and that we can expect worsening as time goes by

[National Jewish]

It is very difficult to be specific because every person is affected so differently by chronic obstructive pulmonary disease (COPD).  What can be said is that your family member will advance from one stage of COPD to the next stage at a faster rate as long as he continues to smoke.  This will generally decrease his quality of life and his life expectancy.  The most important thing that your family member can do to help himself is to quit smoking.  It is not possible to say that this will stop his progression to the next stage of COPD, but it will slow down the rate of progression.

You may want to look at our Quit Smoking Topic Center at http://www.nationaljewish.org/topic/smoking_cessation.html for ways to help your family member to quit smoking.  Also check with your family member’s doctor for other quit smoking resources in your area.

Each stage of COPD is based on symptoms and measured loss of pulmonary function, especially the forced expiratory volume in the first second (FEV1).  The FEV1 is the amount of air that can be forcefully expelled in the first second of exhalation.  It is an indicator of airway obstruction and how far the disease has progressed.  Normal is 80% or greater of the predicted value.  The predicted value for a given individual is based on age, gender and height.

There are 4 stages of COPD:
At risk Stage 0 Normal pulmonary function
Mild Stage 1 Mild reduction in air flow
Moderate Stage 2A FEV1 50 to 80% of predicted
Moderate Stage 2 B FEV1 30 to 50% of predicted
Severe Stage 3 FEV1 less than 30% of predicted

Pulmonary rehabilitation is a program to maintain or bring back your quality of life through aerobic exercise done on a regular basis.  When done routinely, this conditions the entire body so that the muscles are working as efficiently as possible.  This allows the breathing muscles to use the least amount of energy to move air in and out of the lungs.  Over time this helps to lessen shortness of breath and strengthen his legs.  Some programs will also include education about your lung condition and nutrition.  Look for a program that is under the supervision of a lung specialist, also called a pulmonologist.  In such a program, your family member would have a thorough evaluation of all aspects of his condition.  Following this evaluation, this doctor would be the best resource to know if exertion is putting more strain on your family member’s heart and doing more damage than good.  Generally this is not the case.  Please read our Pulmonary Rehabilitation MedFact at http://www.nationaljewish.org/medfacts/pulmonary.html for more information.  Share this information with your doctor to see if this would be helpful and where in your area there are programs.

[shelac]

A related discussion, copd was started.