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  4. COPD
  5. Symptoms & Diagnosis
  6. Diagnosing COPD
  7. Moderate to Severe COPD

Moderate to Severe COPD

COPD is a progressive lung disease meaning your COPD stage and severity can change overtime.
three generations of women sitting side by side and smiling into the camera three generations of women sitting side by side and smiling into the camera

In the moderate to severe stage, there is more inflammation and damage in your lungs, reducing your airflow and causing lower oxygen levels in your blood. This can lead to more breathing-related symptoms and changes in your treatment plan. 

Diagnosis

Moderate to severe COPD means you have:

  • more noticeable, changing or worsening symptoms
  • increased infections, flare ups or exacerbations
  • increased difficulty doing everyday activities 
  • a decline in your lung function
  • lower oxygen levels 
  • new or worsening secondary health conditions such as swelling in your legs or pulmonary hypertension 
  • changes in how well your existing treatment plan and medications are working
Learning to Live with Chronic Obstructive Pulmonary Disease (COPD): A workbook for patients, families, and caregivers. Cover image showing an older couple dancing outdoors, smiling and embracing joyfully.

It is important to discuss new or changing symptoms with your healthcare provider. When talking to your provider, be specific and offer examples about how these symptoms have affected your everyday activities. Instead of saying “I get short of breath”, try saying “I get more short of breath when I use the steps.”

To determine if your COPD is getting worse, your provider will review the results of your lung function tests such as spirometry, oxygen levels, and exercise tests. Your provider will also look at your risk and history of exacerbation or flareups, symptoms and your other health conditions. 

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Treatment

In the moderate to severe stages, your healthcare provider may recommend new treatment options. These treatment options include:

The medications your healthcare provider prescribes will depend on your symptoms and history or risk of exacerbations. In addition to your short acting medication, your healthcare provider may consider medications such as LABA, LABA/LAMA/ICS (also called triple therapy), or biologics. 

Pulmonary rehab (PR) is a program that combines medically supervised exercise, education and social support to increase awareness about your lungs and COPD. 

Oxygen therapy is a treatment option that is prescribed by your healthcare provider if you have low oxygen levels. 

Endobronchial valve therapy or EBVs are a safe and effective treatment option if you have severe emphysema. EBVs are removeable, one-way valves that reduce lung hyperinflation by allowing the trapped air to escape.  

The goal of lung volume reduction surgery is to remove the area of the lung most affected by disease, allowing the remaining lung to function more efficiently, and improve your breathing ability and quality of life. 

While rare, a bullectomy is a surgery that removes one or more of the large, damaged air sacs called bullae or blebs.

Lung transplantation of one or both lungs may be a treatment option if you are living with severe lung disease that no longer responds to medications or other treatments.  

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Management

Along with your medication and other treatment options, there are ways to manage COPD. Talk to your healthcare provider about any changes in your lung health, nutrition or activity levels. 

Living with moderate to severe COPD can have physical challenges. You can learn ways to conserve your energy and use deep breathing exercises to complete daily activities and stay active. The foods you eat and your weight can also play a role in helping manage your COPD.

As your COPD progresses, you may also find you feel too tired to eat or get short of breath during meals. Talk to a registered dietitian or your healthcare provider about your nutrition and any challenges you have with eating. This is especially important if you have unexplained weight loss, are less interested in eating, too tired or get short of breath.

Have an up to date COPD Action and Management Plan and make sure it is somewhere you and your family can easily access it. This plan can help you recognize your everyday COPD symptoms and what steps to take when your symptoms are getting worse.  These daily symptoms may include shortness of breath or coughing up mucus.

It’s not always possible to prevent exacerbations but you can reduce your risk by avoiding your COPD triggers. These are things, activities, or conditions that can cause or worsen your symptoms. Some of the more common triggers include tobacco or woodburning smoke, infectious lung diseases such as flu or pneumonia, strong odors, fumes, chemicals, changes in temperatures or air pollution.

In addition to physical challenges, you may also have changes in your emotional health. Talk to your healthcare provider about changes in your mood such as sadness, anxiety or depression. Living with chronic lung disease can be isolating. You may find connecting with others through online support communities or attending support groups helpful. You should also talk to your provider about supportive care options such as palliative care and hospice. 

People living with COPD are more likely to have other health conditions such as heart disease or pulmonary hypertension. When you have comorbid or other health conditions, such as heart disease or diabetes, it can lead to worse health outcomes and COPD exacerbations can increase your risk of hospitalization. 

When you have COPD and continue to smoke or vape, your lungs are more vulnerable to the harmful chemicals from tobacco products. This puts you at risk of worsening lung function and a COPD flare up or exacerbation. You do not have to quit alone. Speak with your healthcare provider about your desire to quit tobacco use, and ask for help to locate local resources, create a plan and support your effort.

My COPD Action Plan — American Lung Association. A structured medical action plan with three color-coded zones indicating COPD symptom severity and recommended actions: Green Zone (doing well): Lists daily activities and actions to maintain health Yellow Zone (having a bad day or COPD flare): Lists warning symptoms and corresponding actions, including medication adjustments Red Zone (needing urgent medical care): Lists severe symptoms requiring immediate attention and emergency actions Includes the American Lung Association logo and contact information: 1-800-LUNG-USA | Lung.org/copd

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Page last updated: May 8, 2026

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