The Stages of Emphysema -- and What to Expect

Medically Reviewed by Paul Boyce, MD on March 18, 2021

Doctors describe how bad your emphysema is by using what they call “stages.” They use two main methods to come up with this information -- the GOLD Emphysema Staging System and the BODE Index. Read on to learn more about each of them.

The GOLD Emphysema Staging System

This is a set of guidelines established by the Global Initiative for Chronic Obstructive Lung Disease (GOLD).

It measures how much air you can blow out of your lungs in 1 second. Doctors call this the forced expiratory volume (FEV1).

If you have emphysema, your doctor will look at your FEV1. They’ll also look at your other symptoms, as well as how many times you’ve been hospitalized in the past year because of them. Doctors call this an “exacerbation.” It means your symptoms flare up or suddenly get worse.

Your doctor may also do a CT scan of your lungs. They’ll then use all of this information to place you into one of the following four groups (they tell you how severe your emphysema is):

Group A (GOLD 1 or 2): Your symptoms are very mild. Your FEV1 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 FEV1 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): Air flow into and out of your lungs is severely limited. Your FEV1 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. Any new flare-ups could be life-threatening.

The BODE Index

This staging system measures how much emphysema impacts your daily life. It looks at four main areas:

Body mass index(B). This describes how much body fat you have compared to your height and weight.

Airflow limitation(O for obstruction). Your doctor can tell how damaged your lungs are by how well you do on pulmonary (lung) function tests.

Breathlessness(D – doctors call it “dyspnea”). Your doctor will ask you a series of questions about how often you feel like you’re out of breath, and when.

Exercise capacity (E). This measures how far you can walk in 6 minutes.

Studies show that the BODE Index gives doctors a better idea about your outcome (what they call a “prognosis”) than FEV1. And they can use those findings to see how well you’ll respond to medications, lung rehab therapy, and other treatments.

Emphysema gets worse over time, and it affects everyone differently. That means there’s no way doctors can know for sure who long you can expect to live if you have it.

Your doctor will use information about the stage of your disease to come up with the best treatment plan for your special case.

Show Sources


UpToDate: “Chronic Obstructive Pulmonary Disease: Definition, Clinical Manifestations, Diagnosis, and Staging.”

Albert R. Clinical Respiratory Medicine, Mosby Elsevier, 2008.

American Lung Association: "Diseases A-Z: Emphysema."

National Heart Lung and Blood Institute: "Diseases and Conditions Index: COPD."

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