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Stages of COPD

The Stages of COPD Define the Disease According to Severity

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Updated April 09, 2014

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The GOLD grading system, formerly referred to as the stages of COPD, defines the disease according to its severity. COPD is graded by your doctor using a test called spirometry. Spirometry helps your doctor diagnose the disease and determine the amount of lung damage that is present in your lungs. It also serves as a guide to the initial approach of COPD treatment.

The 4 Grades of COPD Defined

According to the Global Initiative for Obstructive Lung Disease (GOLD), the severity of COPD is divided into four grades (formerly called stages) classified by spirometric measurement: GOLD 1, Mild; GOLD 2, Moderate: GOLD 3, Severe; and GOLD IV, Very Severe.

To get an idea of what grade or stage you're in, refer to GOLD's Spirometric Criteria for COPD Severity Chart at the bottom of this page.

GOLD I: Mild COPD

In GOLD I, Mild COPD, there may be mild airflow limitation but you may be unaware that lung function has started to decline. Forced expiratory volume in one second (FEV1) will be greater than or equal to 80% of the predicted normal values with an FEV1/FVC that is less than 70 percent. You may not yet have any COPD symptoms, or you may have symptoms of chronic cough and excessive mucus. People at this stage are not likely to associate symptoms with the disease process and therefore, rarely seek treatment.

GOLD II, Moderate COPD

During GOLD II, Moderate COPD, airflow limitation worsens and you may start to notice symptoms, particularly shortness of breath upon exertion along with cough and sputum production. Your FEV1 will be anywhere between 50% and 79% of the predicted normal values and your FEV1/FVC will be less than 70 percent. It is during this stage most people typically seek medical treatment.

GOLD III, Severe COPD

Once the disease has advanced to GOLD III, Severe COPD, limitation of airflow significantly worsens, shortness of breath becomes more evident and COPD exacerbation is common. Your FEV1 will be between 30% and 49% predicted and your FEV1/FVC will be less than 70 percent. If you reach this stage, you may notice a decrease in your activity tolerance and an increase in fatigue-ability.

GOLD IV, Very Severe COPD

By the time a COPD patient reaches GOLD IV, Very Severe COPD, their quality of life is greatly impaired and COPD exacerbations are life threatening. Airflow limitation is severe (FEV1 less than 30% predicted or less than 50% predicted and your FEV1/FVC will be less than 70 percent. Chronic respiratory failure is often present at this stage, and may lead to complications with your heart, such as cor pulmonale and/or eventually, death.

Who Needs Spirometry?

Being a current or former smoker places you at high risk for COPD. That said, if you still smoke, you are strongly encouraged to quit. Additionally, if you have any COPD-related respiratory symptoms, like shortness of breath, increased mucus, or a cough that won't go away, you should talk with your doctor about getting a spirometry test to confirm or negate a diagnosis of COPD.

Changing the Outcome of Your Disease

It is important that people with COPD understand that the COPD grading system is only meant to be used as a guideline. What's more important is how well you take care of yourself and how you feel.

There are steps that you can take to prevent COPD from advancing more rapidly that may also change the course of your disease. Read more about them in How to Keep Your COPD From Getting Worse.

GOLD Spirometric Criteria for COPD Severity
I. Mild COPD* FEV1/FVC < 0.7

* FEV1 > or = 80% predicted

At this stage, the patient is probably unaware that lung function is starting to decline
II. Moderate COPD * FEV1/FVC < 0.7

* FEV1 50% to 79% predicted

Symptoms during this stage progress, with shortness of breath developing upon exertion.
III. Severe COPD* FEV1/FVC < 0.7

* FEV1 30% to 49% predicted

Shortness of breath becomes worse at this stage and COPD exacerbations are common.
IV. Very Severe COPD* FEV1/FVC < 0.7

* FEV1 < 30% predicted or FEV1 < 50% predicted with chronic respiratory failure

Quality of life at this stage is gravely impaired. COPD exacerbations can be life threatening.

Source:

Global Strategy for the Diagnosis, Management and Prevention of COPD. The Global Initiative for Obstructive Lung Disease. Revised 2011.

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