COPD Stages: Changing The Way They Are Used

In a previous post, I described ” How COPD Stages Are Helpful.” In this post, I would like to explain how the usefulness of these stages is limited. In other words, these stages are helpful, but not as much once as once thought.  What do I mean by this? Read on and I’ll explain.

First off, let’s review briefly the stages of COPD.

What are the Stages of COPD?

The Global Initiative For Obstructive Lung Disease (GOLD) has created guidelines. In these guidelines, they defined the four stages of COPD. They are as follows1-3.

This staging system is nice. It’s easy to do. It’s easy to determine how much airflow limitation a person has. It’s useful for determining how severe your COPD is3.

It was thought that it’d be helpful for treatment

But, that’s how far this usefulness goes, according to some experts. It was once thought that knowing your stage would also be useful for helping doctors best treat you on a day to day basis. But, this did not prove to be the case3.

Why?

This is best explained by the authors of the 2017 Gold COPD Guidelines. They said: “It was believed, at the time (when the stages were first created), that the majority of patients followed a path of disease progression in which the severity of COPD tracked the severity of airflow limitation.3

But, not so fast!

The problem is that this staging system assumes all people with COPD are the same. It assumes that airflow limitation correlates with disease severity. It assumes a person can be treated based on disease severity alone3.

But, that didn’t turn out to be the case

Why?

Because, it was observed, that some people with moderate COPD had moderate limitations to what they could do. But, at the same time, some people with moderate COPD had severe limitations on what they could do4.

Likewise, some people with severe COPD had moderate limitations to what they could do. But, some people with severe COPD had no limitations at all to what they could do4.

So, the guidelines now account for this. This is from the 2017 GOLD COPD Guidelines: “At an individual level, FEV1 is an unreliable marker of the severity of breathlessness, exercise limitation, and health status impairment3.”

So, based on newer evidence, COPD staging is no longer considered a reliable indicator of how you feel. Therefore, it cannot be used as a guide to how best to treat you on a daily basis3-4.

What is the ABCD Assessment Tool?

It’s a neat new tool to help doctors best treat you. It involves asking you questions. It involves filling out simple questionnaires. It involves looking at your chart. The goal is to determine how COPD affects you on a daily basis. Then you are ranked into four categories: A, B, C, or D.4

  • A. You have minimal symptoms and not much of a risk of having flare-ups.
  • B. You have more symptoms but still a minimal risk for having flare-ups.
  • C. You have minimal symptoms but a high risk for having flare-ups.
  • D. You have severe symptoms and a high risk of having flare-ups.6

Technically, you could fit into any of these categories regardless of what stage you are in. And, based on what category you are in (A, B, C, or D) your doctor can determine how best to treat you.

In an upcoming post, I will go over this new tool in more detail. In the meantime, I just wanted to let you know it exists. This new tool is kind of neat, I think. Some doctors may not be using it yet. But, if your doctor has you fill out a survey, it’s possible it’s to determine where you fit on this new ABCD Assessment Tool.

What to make of this?

Knowing what stage you are in is useful. But, the GOLD COPD Guidelines no longer recommend it be used to determine treatment. Instead, they prefer doctors to use this new ABCD Assessment Tool. I will go over it in more detail in an upcoming post.

So, stay tuned!

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