What Are the Stages of COPD?

Chronic Obstructive Pulmonary Disease (COPD) may sound like one single condition, but it includes several kinds of lung diseases. All of them can make you feel breathless.

Doctors use stages to describe how severe your COPD is. This classification system is called the GOLD staging or grading system. Your stage will affect what treatment you get.

It’s a complicated system that looks at many different things. The basic idea is to understand how severe your COPD is and what type of treatment you need.

What Is the GOLD System?

The GOLD system bases the stage of your COPD on several things:

  • Your symptoms
  • How many times your COPD has gotten worse
  • Any times you’ve had to stay in the hospital because your COPD has gotten worse
  • Spirometry, a test that checks the amount (volume) of air and speed (flow) that you can exhale

GOLD stands for the Global Initiative for Chronic Obstructive Lung Disease. The National Heart, Lung, and Blood Institute, National Institutes of Health, and the World Health Organization started it in 1997.

GOLD helps raise awareness of COPD and works with doctors and other health experts to improve prevention and treatment strategies. It also develops the guidelines most doctors use to classify and treat COPD.

Spirometry and Your COPD Stage

Spirometry results are based on two measurements:

Forced vital capacity (FVC). This is the largest amount of air you can breathe out after breathing in as deeply as you can.

Forced expiratory volume (FEV-1). FEV-1 shows how much air you can exhale from your lungs in one second.

The original GOLD stages relied only on FEV results. But now doctors consider other things, too.

GOLD Stages or “Grades”

The original GOLD system used the term “stages” to refer to the different levels of COPD. Now they’re called “grades.” Experts believe this new grading system allows doctors to better match patients with the right treatments.

Your doctor will assign grades to four separate pieces of information:

  • How severe your current symptoms are
  • Your spirometry results
  • The chances that your COPD will get worse
  • The presence of other health problems


Symptom Grades

You’ll fill out a questionnaire -- usually, the COPD Assessment Test (CAT) or the Modified Medical Research Council (mMRC).

CAT scores range from 0-40 and mMRC scores have four grades. For example, if you report that you only get winded when you do hard exercise, you might have mMRA Grade 0. If you report being so breathless you can’t even leave the house or get dressed, you could have mMRA Grade 4.

Spirometry Grades

To check how well your lungs work, your doctor will look at your spirometry results. These results have four grades, too:

  • GOLD 1: mild
  • GOLD 2: moderate
  • GOLD 3: severe
  • GOLD 4: very severe

Exacerbation Risk

Another thing that’s part of your overall COPD assessment is your “exacerbation risk.” An exacerbation is a time when your COPD symptoms get much worse, so that you need to make a change in your medication. These flare-ups are more likely if your spirometric result is GOLD 3 or GOLD 4.

Other Health Problems

If you have other health problems, your doctor will consider those, too. It’s all part of assessing your COPD and what type of treatment is best for you.

COPD Groups

Based on all of these things -- your symptoms, spirometry results, and exacerbation risk -- your doctor will put your COPD into one of these groups:

· Group A: Low risk, less symptoms

· Group B: Low risk, more symptoms

· Group C: High risk, less symptoms

· Group D: High risk, more symptoms

If you have questions about any terms that your doctor uses -- whether “grades” or “groups,” ask. There is a lot of information available and the best way to control your COPD is to learn as much as you can about it so that you will feel better.

WebMD Medical Reference Reviewed by Carol DerSarkissian on December 23, 2018


COPD Foundation: “What is COPD?”

Global Initiative for Chronic Obstructive Lung Disease: “Global Strategy for Diagnosis, Management, and Prevention of COPD – 2016,” “The Global Initiative for Chronic Obstructive Lung Disease (GOLD).”

American Family Physician, Nov. 16, 2013.

UpToDate: “Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging.”

Mayo Clinic: “Spirometry.”

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