9 Tips to Retain Lung Function With Stage III COPD

Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder characterized by the restriction of airflow into and out of the lungs. It affects more than 600 million people worldwide and accounts for more than four million deaths annually.

The Global Initiative for Obstructive Lung Disease (GOLD) classifies COPD into four stages, with the mildest form being stage I and the most severe being stage IV. If you are diagnosed with stage III COPD, it means that your lung function has been seriously impaired with increased shortness of breath, wheezing, and fatigue making daily function increasingly difficult. Symptoms may have even resulted in one or more hospitalizations.

Even at this more advanced stage of COPD, there are things you can do to retain the breathing capacity you have and prevent (or at least slow) further progression of the disease.

Ways to retain lung function in Stage 3 COPD
Illustration by Jessica Olah, Verywell

Put Out the Cigarettes

Quitting smoking is the one thing you need to do at any stage of the disease. Not only will stopping make you feel better physically and emotionally, it can also dramatically slow the progression of the disease. Smoking damages the air sacs, airways, and lining of your lungs, the injury of which can make it harder to inhale and exhale. Smoking can also trigger COPD flare-ups.

Quitting can be tough, but there are several treatments that have been scientifically proven to work, including behavioral therapy, individual, group, or telephone sessions, nicotine replacement products, counseling, and medication.


Tips to Help You Quit Smoking

Get Your Flu and Pneumonia Shots

According to GOLD, annual flu shots can reduce the risk of illness and death in people with COPD. The pneumonia vaccine is also recommended for people 65 years of age and older to better reduce the risk of bacterial pneumonia.

People with COPD have compromised lung function and, as such, are at high risk of getting the flu. When pneumonia develops, the damage caused to the lungs can be irreversible. If you are living with Stage III COPD, the prevention of flu and pneumonia is considered essential because once lung infection occurs, any damage caused will be permanent and only advance your disease that much further.

Always Keep Your Rescue Inhaler Close at Hand

Although bronchodilators do little to slow the progression of COPD, your healthcare provider will recommend one to treat any flare-ups or shortness of breath. Short-acting bronchodilators like Albuterol or Proventil (also known as rescue inhalers) are used on an as-needed basis for the relief of persistent or worsening respiratory symptoms.

Ultimately, the less stress you put on your lungs here and now, the less cumulative damage they will likely incur moving forward.

Use Your Long-Acting Bronchodilators as Prescribed

Long-acting bronchodilators are commonly used as the disease progresses to help you prevent or reduce symptoms. Your healthcare provider may recommend that you combine bronchodilators with different modes of action because this method may be more effective, with equal or fewer side effects, than using just one bronchodilator alone.

In fact, for those who experience shortness of breath and/or exercise intolerance (most people at this stage), 2020 guidelines strongly recommend using a combination of a long-acting beta-agonist (LABA) and a long-acting anticholinergic/muscarinic antagonist (LAMA) rather than either of these types of bronchodilators alone.

Long-acting ​beta-agonists are one type of bronchodilator containing medications like salmeterol or formoterol. Long-acting anticholinergics are another type using containing medications such as tiotropium, aclidinium, or glycopyrronate.

It's important to look at the generic names of your medications to make sure you aren't doubling up on any one drug.

Don't Forget Your Daliresp

Phosphodiesterase-4 (PDE4) inhibitors are a class of drug that treats inflammation associated with COPD. A once-daily oral medication, PDE4 inhibitors help reduce COPD exacerbation with typically minimal side effects. The drugs work by reducing airway inflammation in people who are resistant to standard therapies. By doing so, less mucus is produced, resulting in less accumulation and obstruction of air passages.

Daliresp (roflumilast) and the generic form, roflumilast, are the only two PDE4 inhibitors currently approved in the United States. The main side effects of PDE4 inhibitors include diarrhea, nausea, and headaches.

Take Pulmonary Rehabilitation Seriously

Pulmonary rehabilitation is generally added during stage II COPD and continued as the disease progresses. It includes exercise, relaxation, breathing techniques, airway clearance, and emotional support to help people better cope with their condition. Among the aims is to avoid the need for oxygen therapy indicated in stage IV COPD.

Pulmonary rehab can help reduce disease symptoms, improve the quality of life, decrease social isolation, and increase survival time. The program uses a multidisciplinary team of nurses, physical and occupational therapists, dietitians, and counselors.

Speak With Your Healthcare Provider About Glucocorticoids

Treatment with glucocorticoids (commonly known as steroids) is controversial, but GOLD recommends them in the inhaled form once you reach Stage III and are suffering from frequent exacerbations. They may not be appropriate for everyone, however, and it's important to talk to your healthcare provider to see if you need this medication if you don't also have asthma or if you haven't had a COPD exacerbation in over a year.

Oral steroids may be used temporarily to treat COPD when symptoms rapidly get worse. Inhaled steroids, by contrast, are typically used to treat stable symptoms or when symptoms are slowly getting worse.

Eat Healthy to Improve Lung Function

While a healthy diet cannot cure COPD, it can help you feel better and provide more energy for all of your daily activities, including breathing. The simple fact is that COPD places enormous stress on your body and effectively burns up all of the fuel you get from eating. As such, people with COPD will often need to increase their caloric intake, ideally with healthy foods rich in antioxidants and phytochemicals.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Global Initiative for Obstructive Lung Disease (GOLD). Pocket Guide to COPD Diagnosis, Management, and Prevention: A Guide for Health Care Professionals.

  2. Centers for Disease Control and Prevention. Quitting smoking.

  3. Tashkin DP, Fabbri LM. Long-acting beta-agonists in the management of chronic obstructive pulmonary disease: current and future agents. Respir Res. 2010;11:149. doi:10.1186/1465-9921-11-149

  4. Nici L, Mammen MJ, Charbek E, et al. Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. 2020. 201(9). doi:10.1164/rccm.202003-0625ST

  5. U.S. Food and Drug Administration. Daliresp Prescribing Information.

  6. Corhay JL, Dang DN, Van cauwenberge H, Louis R. Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy. Int J Chron Obstruct Pulmon Dis. 2014;9:27-39. doi:10.2147/COPD.S52012

  7. Rawal G, Yadav S. Nutrition in chronic obstructive pulmonary disease: A review. J Transl Int Med. 2015;3(4):151-154. doi:10.1515/jtim-2015-0021

By Deborah Leader, RN
 Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD.