COPD Stages By GOLD Guidelines
In the text below the tool you can read more about the stages, symptoms and differential diagnosis of COPD.
This tool retrieves the disease severity stage for patients who suffer from chronic obstructive pulmonary disease, based on the Global Initiative on Obstructive Lung Disease classification.
In order to use it, the forced expired volume in one second (FEV1) and forced vital capacity (FVC) levels must be measured by spirometry and level of dyspnea described.
The GOLD initiative stratifies patient’s disease by COPD stages and helps clinicians create a framework of in and out hospital management.
Although not specific on this, the COPD stage can be associated with other patient factors and comorbidities to provide prognosis in terms of survival.
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COPD stages explained
The Global Initiative for Chronic Obstructive Lung Disease provides guidelines for the stratification of COPD in stages.
This is done by accounting for the FEV1, which is the amount of air you can forcefully exhale in 1 second, and for dyspnea degree. As COPD progresses airflow becomes more and more limited.
The five COPD stages are introduced in the table below:
|Stage||COPD severity||Other information|
|0||No diagnosis||The patient is still at risk with chronic cough and sputum production present despite normal spirometry.|
|I||Mild COPD||Mild airflow limitation (FEV1/FVC less than 70% but FEV1 80% or more than predicted).|
|II||Moderate COPD||Worsening airflow limitation (FEV1 50-79% predicted) and usually progression of symptoms, with shortness of breath on exertion.|
|III||Severe COPD||Further worsening of airflow limitation (FEV1 30-50% predicted), increased shortness of breath, and repeated exacerbations.|
|IV||Very severe COPD||Severe airflow limitation (FEV1 less than 30% predicted) or the presence of chronic respiratory failure.|
Medical professionals use this stratification method to devise in and out hospital management and strategy.
There are other prognosis assessments that reflect disability caused by obstructive lung disease, such as the BODE index or the modified MRC dyspnea scale.
About the disease
Chronic obstructive pulmonary disease is a chronic, progressive disease that includes emphysema and chronic bronchitis.
Emphysema gradually damages the elasticity of the airways and the alveoli whilst in chronic bronchitis, the air passages in the lungs become inflamed.
COPD is characterised by restriction of airflow into and out of the lungs.
The obstruction is caused by the inflammatory response of the lungs to damage to the parenchyma and airway structures.
The most common symptoms are shortness of breath, coughing, excessive sputum production and fatigue. Other signs relevant include a protruded chest and pale or cyanotic teguments.
Some COPD presentations may also include wheezing, effort intolerance, flapping tremor and sometimes limb edema.
Differential diagnosis needs to take place with congestive heart failure, bronchopulmonary dysplasia, pneumoconiosis, lung malignancy or some types of anemia.
The presence of obstruction and its degree are evidenced through post-bronchodilator spirometry. Diagnosis also includes CT scanning, full blood count (for anemia or polycytemia)as well as a basal metabolic index to check the weight status (as obesity is a severity factor).
If left untreated, COPD progresses to exacerbated dyspnea, chronic hypoxemia which in turn may lead to pulmonary hypertension and ventricular hypertrophy.
Diagnosis through spirometry
Spirometry is a type of respiratory test that measures the amount of air a person can breath in and out, performed with a spirometer. The determinations required for COPD diagnosis are:
■ FVC – forced vital capacity, which is the maximum volume of air that can be exhaled during a forced attempt.
■ FEV1 - forced expired volume in one second, which is the volume expired in the first second of maximal expiration and measures the rapidity by which the lung is emptied.
■ FEV1/FVC – which is FEV1 expressed as a percentage of the FVC and a measure of airflow limitation. The ratio FEV1/FVC should be between 70% and 80% in normal adults. Any value below 70% indicates airflow limitation, with less than 35% meaning very severe limitation.
1. Petsonk EL, Hnizdo E, Attfield M. Definition of COPD GOLD stage I. Thorax. 2007; 62(12): 1107–1108.
2. Marin JM, Cote CG, Diaz O, Lisboa C, Casanova C, Lopez MV, Carrizo SJ, Pinto-Plata V, Dordelly LJ, Nekach H, Celli BR. Prognostic assessment in COPD: health related quality of life and the BODE index. Respir Med. 2011; 105(6):916-21.
3. Celli BR, Cote CG, Lareau SC, Meek PM. Predictors of Survival in COPD: more than just the FEV1. Respir Med. 2008; 102 Suppl 1:S27-35.
App Version: 1.0.1
Coded By: MDApp
No. Of Items: 5
Published On: June 1, 2017 · 10:07 AM
Last Checked: June 1, 2017
Next Review: June 1, 2018