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Staging for COPD

Getting a COPD diagnosis is downright scary. So many emotions and questions go through your head and trying to make sense of it all seems like an impossible feat. One question I am asked a lot by newly diagnosed COPD patients is to explain the staging of the disease. Often times a doctor will give the diagnosis of COPD but not go further than that. In the past, doctors would diagnose COPD based on simple spirometry alone. The lower your score on the breathing test, the worse your COPD was. In 1997 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) came up with new guidelines for diagnosing and staging COPD. The guidelines combined spirometry, symptoms and exacerbations to diagnose and stage the disease.

I wanted to take some time to explain the 4 COPD stages and how each is diagnosed.

Before I go too in depth here are a few definitions that will be helpful to know.

FEV1 stands for Forced Expiratory Volume in the first second. This is the amount (volume) of air that can be forced out in the first second after taking as deep of a breath as you can. Think of it like you’re blowing out a ton of candles on a birthday cake all in one fast deep breath.
FVC is the Forced Vital Capacity. This is the amount of air that can forcibly exhaled out of the lungs after taking as deep of a breath as possible. The maneuver to obtain this measurement is the same as FEV1 and both the FEV1 and FVC can be measured in the same breath/maneuver.
The ratio of FEV1/FVC represents the proportion of your vital capacity (deep breath) that you can blow out in the first second of forced expiration (blowing out hard & fast) to the full vital capacity.

COPD GOLD staging

With all 4 stages, the FEV1/FVC ratio needs to be below 70% predicted to be accurately diagnosed and staged properly.

GOLD stage 1

Mild COPD. In this stage the FEV1 will be greater than or equal to 80% predicted. Many people in stage one aren’t aware they even have COPD because the symptoms are mild and not usually bothersome. Often the first symptoms of COPD are coughing and increased mucus production.

GOLD stage 2

Moderate COPD. In this stage the FEV1 will be between 50% and 80% predicted. Symptoms are more noticeable and progressing downward. Shortness of breath, especially on exertion develops. Increased mucus production as well as finding it more difficult to expel. Coughing frequency increases and becomes more persistent. Most people are diagnosed at stage 2.

GOLD stage 3

Severe COPD. In this stage the FEV1 will be between 30% and 50% predicted. Shortness of breath becomes more prominent in this stage and normal daily activities tend to become increasingly difficult. COPD exacerbations (flare ups) are commonly seen at the beginning of this stage often requiring hospitalization. Supplemental oxygen is often times needed at this stage.

GOLD stage 4

Very Severe COPD. In this stage the FEV1 is less than 30% predicted OR FEV1 is less than 50% with chronic respiratory failure. Supplemental oxygen is required to maintain adequate oxygenation and exacerbations can be life threatening. Quality of life is severely impacted.

While there is no cure for COPD, there are many treatments to help slow the progression of the disease. Having a support system is also very important. No matter what stage of COPD you are in, know that you are not alone.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The COPD.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Manzanopeek
    2 months ago

    Thanks

  • Leon Lebowitz, BA, RRT moderator
    2 months ago

    It’s our pleasure, Manzanopeek. Glad you found this article (by our own Theresa Cannizzaro), to be helpful for you. Wishing you well, Leon (site moderator)

  • OSUFAN60
    2 years ago

    I’m 80. I was just diagnosed with COPD about 3 weeks ago. Theresa’s explanation of stages was very helpful. My doctor never even mentioned it. I wonder why. Theresa mentions that so it is common that the don’t. Why? Is it not recognized by some professionals?
    My diagnosis process is interesting. While going through the PREOP phase for a hip replacement surgery (which I successfully had yesterday and writing this in the hospital), I mentioned to my primary car doc that recently I started wheezing in the night while laying down for a while. It was usually accompanied by unproductive coughs. Well..after a chest X-ray my doc sent me to a pulmonary doc. There, in a glass box for an hour, I discovered COPD. Wow! Hip replacement is no walk in the park, no pun intended…it’s my second. But 3 weeks before that to add COPD to the mix. I was not a happy camper. But after leaning more about it from this network and other resources, I’m coping better. I think Theresa’s stages puts me between a 1 & 2. With my inhalers, my wheezing and related coughs have almost disappeared. And today I’m up and walking….SLOWLY with a walker. I will eventually be able to get rid of the walker. But, it looks like the inhalers are here to stay.
    I see my pulmonary doc in 3 months and plan to ask him why he didn’t mention the stages to me.

  • Leon Lebowitz, BA, RRT moderator
    2 years ago

    Hi OSUFAN60 and thanks for sharing your experiences. Wow, your second hip surgery and now being diagnosed (at age 80) with COPD! Interesting it took your physician until now to make that diagnosis. It sounds (from what you’ve written) like you’re recovering quite nicely from the surgery AND in terms of coping with your new diagnosis of COPD.
    It will be interesting to hear your doc’s response to your question.
    Please check back with us and let us know how you’re doing.
    All the best,
    Leon (site moderator)

  • Ell
    2 years ago

    Hi,
    I was diagnosed with stage 1 COPD in 2005 and it’s slowly gotten worse. I’m at stage 4 emphysema. My life is basically spent in bed. One of the hardest things I had to do was stop driving. That’s always been important, just get in the car and go. I’ve got short term memory loss and I started getting lost so I wasn’t able to go anywhere alone. I’ve not been able to get outside much in the past 6 months and I really miss that.
    But there’s still life to live. I’ve started a full time Bible study and journal and I’m enjoying it. I also crochet a lot. I do the typical things like watch TV and read but I also color. The adult coloring phenomenon is great ☺. I’ve started doing some creative writing as well. When I have company I play cards and board games. I’ve also started bringing back the art of letter writing. I used to love getting letters in the mail and my friends and family enjoy receiving them.
    I just wanted to share my experience with everyone. And please know that there’s a lot of living to be done. I’m thinking about learning a new language. Lots of handy videos online.
    Have a great day…. Que tengas un gran day ☺

  • Leon Lebowitz, BA, RRT moderator
    2 years ago

    Hi Ell and thanks so much for sharing your experiences dealing with COPD over the years. It sounds like you’ve got a great attitude and approach to being productive from home coping with the disease. I’m sure others will read about your feeling and get ideas for themselves as well.
    All the best,
    Leon (site moderator)

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