What if asthmatic horse doesn't get proper care?

He is a 13yo gelding, coughing for 6 months now, diagnosed copd. His owners didn't change anything. He has dusty hay and sawdust, one hour on the field, and is ridden 3 times a week for half an hour. Completly closed in the stall in winter. No medications. He coughs in trot and on hills. He breaths hard while resting - he shows ribs (and he's a bit fat) when he breaths in, he helps himself with belly muscles. You can hear that his breathing is off just by standing beside him.
What will happen to him? How much could he get better if he get proper care? And how long until he'll get worse with this care?
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He'll get worse until all his strength is used to try to keep breathing. He'll be miserable, won't want to eat etc. It's a bad way for a horse to die.
ETA: Missed one of your questions. More turnout could improve him but the dusty hay is the biggest culprit. That dust keeps inflaming his lungs. He could get much better with proper care but will likely always be limited.

This.
Do you know if, when the diagnosis was given, any information was given to them about the changes that could be made to benefit him? Many times the things that seem obvious to us aren't obvious to others, hard as it is to believe in a situation like this.

Vet told them how to take care of him. I'm telling them over and over again. They ask me about it every time we meet, and say they don't know how to help him. I tell them and then they make fun of me, saying that I'm as smart as vet and that he told them the same stuff. They laugh at advices or say they'll do it and then they don't. I thought he was doing better, it's long since I saw him and now they asked me to take care of their horses for a week and he is worse than the last time I saw him. And no special care for him. I wet his food and bedding (it was so bad it made me cough) and informed owners about it. I still didn't get response. I can't do a lot for him. It's only a week and in the morning someone else feeds them and doesn't wet hay. I feel like crying every time I go back home. I know this horse for years...
What do you think, how long? How much time is left for him until he'll have to be euth?
Should I confront owners when they come back? I don't think they'll take me serious... I'm 18. Not that my age should be the problem, since they don't think vet is giving good advices either.
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If I were you I would continue to fulfill my obligation until they get back.
I would then tell them that they are being stupid & cruel & I won't be a part of it. I care for that horse & cannot stand by & watch him slowly die. It shocks me that you have no problem with it. Please do not contact me any more for any reason.

I'm proud of any 18 year old who speaks her mind when something needs to be said.

Agree with the above. Furthermore I would tell them they'd be better off shooting the thing if their vet told them how to take care of him but they "still don't know what to do" because it would certainly prevent the ANIMAL from having to deal with THEM any further.

But I'm kinda mouthy like that haha.
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Ok, if he is at a boarding stable, the stable hands and BO need to help manage this situation. Hay needs to be dunked, the stall is better off being stripped than having soggy bedding. Turnout is a plus but if it is dusty out, its a draw. He will get temporarily better once the weather turns. The late spring/summer is the worst for them.

Is he on any medications? Did the vet recommend anything other than maintenance?

I truly think it is cruel to be still riding this horse if he is in such bad shape. Imagine yourself in a full asthma attack and being told to get back to work.

It's their barn. They have very nice turnouts, not dusty, but doesn't want to use them to much, cause there will be no more grass if they graze more than an hour a day... They are always worried how their property looks.
Vet said he can give him some medications with corticosteroids in it, and they turned it down, saying that this will destroy him, and he'll get some other ilness, that it will do bad to his liver and kidneys...

I watched him closely yesterday when I had him out. He actually seems pretty normal when he walks or stands, but when he eats hay (it wasn't dusty, I wet it) he starts to breath weird - like I said he does first post (showing ribs with breath in and helping himself with belly muscles). I didn't see him troting yet, but I heard him cough when he was on trail ride with his owner few weeks before.

I contacted them again and said that he is not doing ok, and if they won't take care he deserves, he'll be dead after next winter (it's in the winter when he gets worse-he is in a closed stall, no fresh air). I told them their hay is not good as they were telling me and that is bad for any horse, not only ill one. I asked her to tell her boyfriend (who is feeding in the morning) how to wet hay and she seemed worried. She was asking me about the hay and said she'll tell her boyfriend how to do it.
I'm really intrested if she was telling the truth.