What is COPD Staging?

While moderating our community social media platforms, I noticed a post from one of our community members. They asked, “What is end-stage COPD, and what are some symptoms?"

If I had seen this question years ago, when I was first diagnosed, I would probably have had a different answer than I do today. I would have said that the end stage meant that you were in the last stages of your life and only had months to live, not knowing what I know now.

The GOLD staging and COPD

Most of us are familiar with the GOLD staging of respiratory health. It classifies COPD severity from stages 1-4 using a patient's Forced Expiratory Volume (FEV1) scores.¹

GOLD stands for the Global Initiative for Chronic Obstructive Lung Disease. For grading COPD, the GOLD System bases stages of your COPD on several things.^1,2

How many times has your COPD progressed? Have there been times you’ve had to stay in the hospital because your COPD has gotten worse?

What are your results from spirometry testing that checks the amount of air and speed that you can exhale?

What is your FEV score? This is the largest amount of air you can breathe out after breathing in as deeply as possible.

Your FEV1 score is usually used for this grading and shows how much air you can exhale from your lungs in one second.

Doctors will give your FEV1 results a grade:

• Gold 1 (Mild):

Greater than 80%

• Gold 2 (Moderate):

Between 50% and 70%

• Gold 3 (Severe):

Between 39% and 49%

• Gold 4 (Very Severe):

Less than 30%

Doctors also look at exacerbation risk and other health problems. Your doctor will classify your COPD into one of the following groups based on your symptoms, spirometry results, and risk of exacerbation:²

• Group A (GOLD 1 or 2):

Your symptoms are very mild. Your FEV-1 is 80% or more. You might have had no flare-ups over the past year, or perhaps just one. You weren’t hospitalized for your symptoms.

• Group B (GOLD 1 or 2):

Your FEV-1 is between 50% and 80%. You have more symptoms than people in Group A. This is the stage where most people see their doctor for coughing, wheezing, and shortness of breath. You might have had one major flare-up, but you haven’t been in the hospital for your symptoms within the past year.

• Group C (GOLD 3 or 4):

Airflow into and out of your lungs is severely limited. Your FEV-1 is between 30% and 50%. You’ve had more than two flare-ups in the past year, or you’ve been admitted to the hospital at least once.

• Group D (GOLD 3 or 4):

It’s extremely hard for you to breathe in or out. You’ve had at least two flare-ups in the past year, or you’ve been hospitalized at least once. Doctors call this “end-stage” COPD. That means you have very little lung function.

Nowadays, I have a totally different view of this. I have met so many people over the years with different stages of COPD.

Many of them have been at stage 4 or group D for all the years that I have known them, and some have stayed at the same stage for over 20 years. I know others who had mild, or group A, who have declined and are now in group D.

This just goes to show that we all decline at different rates, but one thing we know for sure is that we can try to do some things to prevent this or slow down the progression of COPD. If you haven’t quit yet, stop smoking. That is one way you can slow the progression.

How can you slow the progression of COPD?

Exercise can be hard, and it’s something that I thought I would never be able to do, but I do now, and I try to do something every day. It doesn't matter what it is; you must keep moving. I started slowly but surely and just added a bit more every day.

Eat healthy, and try to stay out of air pollution and cleaners with harmful chemicals. If you want to and are able to get vaccinations, make sure you are getting everything that you need and are keeping them up to date.

I hope this has answered the question and helps those of you wondering about the stages of COPD.

Feel free to add your thoughts or questions below in the comments.