Chronic obstructive pulmonary disease (COPD) is a progressive lung disease, and there are four stages of COPD, known as the GOLD stages, based on the severity of the disease. The highest stage of COPD is Stage IV or very severe COPD. At this stage, the FEV1 (forced expiratory volume in one second) is less than 30% of the predicted normal value, indicating very severe airflow limitation. Symptoms at this stage include severe shortness of breath, chronic cough, and frequent exacerbations that may require hospitalization. People with Stage IV COPD have a significantly reduced quality of life and may require oxygen therapy or even lung transplantation. It’s essential to receive appropriate treatment and management to slow the progression of COPD and improve symptoms at any stage of the disease.