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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.


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


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!

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

  1. “Stages of COPD: MIld Through End-Stage COPD,” COPD Foundation, 2018, February 10,, accessed 7/19/18
  2. COPD Guidelines: Pocket Guide to Diagnosis, Management, And Prevention, Global Initiative for Chronic Obstructive Lung Disease, page 6,, accessed 7/19/18
  3. COPD Guidelines. Global Initiative For Chronic Obstructive Lung Disease (GOLD), 2018, page 1, 28-29
  4. Meldrum, Catherine, presenter, “Introduction to COPD,” MiCMRC Educational Webinar, University Of Michigan, 2017, February 17,, accessed 7/17/18
  5. “Chronic Obstructive Pulmonary Disease Practice Guidelines,” Michigan Medicine: University of Michigan, 2017, November,, accessed 7/19/18
  6. Hayat, Yousaf, "COPD 2017," slideshow presentation, SAIDU Teaching Hospital,, accessed 7/28/18


  • jsimerly9
    9 months ago

    I posted a comment earlier but my talk-to-text let me down with many misspelled words what I was trying to say was I think the whole staging thing that this gold something another doctors said that the staging does not matter I am stage 3 and it is all I can do to even eat take a shower or make through a 8 hour day if they can show me someone in stage 3 or 4 that does not have any limitations then I will believe their ridiculous study but until then I think that hold story was a bunch of baloney

  • jsimerly9
    9 months ago

    I strongly disagree with the staging process in the 2017 gold something other it just sounds ridiculous to me I am in later stage 3 and I thought I could do to even make it to work and back everyday and do 8 hours potato any doctors themselves have had later stage of COPD then they don’t need to be right and crap like that

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