Symptoms of stage 3 and 4 emphysema may significantly affect a person’s ability to perform daily activities, such as showering. People may experience frequent flare-ups, worsening shortness of breath, and more.

Emphysema is a form of chronic obstructive pulmonary disease (COPD). While mild emphysema also involves symptoms of shortness of breath and cough, these symptoms are worse in severe emphysema. The extent of a person’s lung damage can determine how severe their symptoms are.

In certain cases, people with severe emphysema may lose up to 9 years of their life expectancy. Treatment cannot reverse the damage to the lungs, but it can help provide relief and comfort.

This article discusses severe emphysema symptoms and how they compare with mild symptoms. It also examines life expectancy, treatment, and when to contact a doctor.

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There are four stages of COPD. At stages 3 and 4, a person has severe emphysema symptoms.

Stage 3: Severe

Symptoms become intense, and people can experience:

  • frequent flare-ups
  • worsening shortness of breath
  • worsening cough
  • tiredness

Additionally, during this stage, people can experience:

  • wheezing
  • frequent colds
  • swelling in the ankles, feet, and legs

Stage 4: Very severe

During stage 4, blood oxygen levels become very low. People may experience:

  • difficulty catching their breath
  • more frequent and potentially life threatening flare-ups
  • increased risk of heart or lung failure

People who often become short of breath when engaging in daily activities, such as climbing a flight of stairs, should speak with a doctor to find out whether they have emphysema. The earlier they receive a diagnosis, the sooner they can start treatment and take steps toward improving symptoms and quality of life.

After diagnosis, a doctor will give a person an individualized action plan to help them identify a flare-up and what to do when it occurs. An action plan will specify the symptoms that require notifying a doctor and the symptoms that necessitate going to the emergency room.

The symptoms below are examples of those that pose a danger and require immediate medical attention:

Classifying emphysema using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines involves completing tests and questionnaires to determine how severe the condition is.


Once someone receives a COPD diagnosis, doctors classify the severity of the airflow limitation in the lungs. They do so by measuring the amount of air a person can exhale in a second — this is known as FEV1.

Measuring airflow limitations can help determine the following:

  • the impact COPD has on a person
  • the risk of exacerbations (flare-ups)
  • a treatment plan

The GOLD guidelines for classifying airflow limitation are as follows:

StagePredicted FEV1 percentage
GOLD 1 (mild)80% or greater
GOLD 2 (moderate)50–79%
GOLD 3 (severe)30–49%
GOLD 4 (very severe)less than 30%


Assessing symptoms and flare-ups is also necessary for determining someone’s COPD group. This follows from the staging process and requires people to answer a questionnaire.

The questionnaire may ask about symptoms, including breathlessness. The GOLD guidelines use the following classifications to measure symptom severity:

  • Group A: low risk of flare-ups and fewer symptoms
  • Group B: low risk of flare-ups and more symptoms
  • Group C: high risk of flare-ups and fewer symptoms
  • Group D: high risk of flare-ups and more symptoms

Following diagnosis, doctors may offer treatment. However, these options will not cure the condition.

Also, treatment cannot repair the lung damage that emphysema causes. Instead, it reduces further symptoms. The options include:

Lifestyle practices

Unless a person quits smoking or avoids secondhand smoke and other pollutants, their emphysema will worsen. Due to the link between smoking and emphysema, quitting is vitally important.

Other lifestyle practices that may help include:

  • engaging in regular physical activity
  • eating a nutritious diet
  • getting enough sleep

Making these lifestyle changes can delay COPD progression.

Inhaled bronchodilator medications

These open the breathing airways in the lungs, which make it easier to exhale or breathe out.

For the best results, people often use both long-acting and short-acting inhalers. Typically, long-acting medications involve once- or twice-daily use, while short-acting medications need to be used every 4–6 hours.

Pulmonary rehabilitation

This is a program that involves:

  • exercises to build strength, stamina, and flexibility
  • nutritional counseling to help ensure adequate intake of nutrients
  • psychological counseling to help manage stress and cope with co-occurring mental health conditions, such as depression
  • breathing techniques to prevent feeling out of breath
  • education to help quit smoking, conserve energy, and develop a plan to manage flare-ups

Oxygen therapy

Doctors prescribe this when someone’s oxygen level falls below 88%. Supplemental oxygen can help a person breathe better and increase survival in those with severely low resting blood oxygen.


The type of surgery a doctor recommends depends on various factors.

One type involves the removal of damaged parts of the lung so they will not hamper the function of the healthier parts. Another type entails the insertion of one-way valves into the lungs’ breathing tubes, which permits air to leave the healthy parts of the lung.

A lung transplant may be an option for people with stage 4 emphysema.

The life expectancy of an individual with emphysema depends on various factors.

Doctors use scoring systems to help determine a person’s life expectancy. For example, using the GOLD system, a doctor may predict that someone with stage 4 group D symptoms has a shorter life expectancy than someone with stage 1 group A symptoms.

Another useful scoring tool is the BODE index. It uses the following components, which help give the index its name, to generate a score:

  • B: uses the body mass index (BMI)
  • O: the extent of airflow obstruction, also uses FEV1
  • D: dyspnea (shortness of breath) assessment
  • E: exercise capacity, usually measured using the 6-minute walking test

The BODE index is particularly good at predicting survival and exacerbations, including those that require admission to a hospital.

If a person with mild emphysema notices worsening shortness of breath or cough, they could be developing severe emphysema symptoms. These symptoms can have a significant effect on a person’s ability to perform daily activities.

Once emphysema advances to the severe stage, individuals may lose an average of 9 years of life expectancy.

Various treatment options are available, with doctors reserving surgery for the most severe cases.

Getting treatment early and quitting smoking can make a difference in a person’s outlook. A person should speak with a doctor when they first start experiencing shortness of breath during an activity that would not normally seem taxing.