COPD Stages and the Gold Criteria

Chronic obstructive pulmonary disease (COPD) may sound like a 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 system is called the GOLD staging or grading system. Your grade will affect what treatment you get.

The system looks at many things. The basic idea is to understand how severe your COPD is and what type of treatment you need.

What Is the GOLD System for Grading COPD?

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
  • Results from spirometry, a test that checks the amount of air and speed 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 create better ways to prevent and treat this condition. It also creates 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 1 second.

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 system allows doctors to better match patients with the right treatments. The original stages also relied only on FEV results. But now doctors consider other things, too.

Your doctor will assign grades to these four things:

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

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Symptom Grades

You’ll answer some questions, either on the COPD Assessment Test (CAT) or the Modified Medical Research Council (mMRC).

CAT scores range from 0-40 and mMRC scores have five grades. For example, if you report that you only get winded when you do hard exercise, you might have mMRC grade 0. If you report being so breathless you can’t even leave the house or get dressed, you could have mMRC 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 so much worse that you need to make a change in your medication. Your doctor might also call it a flare. These flare-ups are more likely if your spirometry result is GOLD 3 or GOLD 4.

Other Health Problems

Your doctor will consider other health problems you have, too. It’s all part of grading your COPD and deciding 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’s a lot of information out there, and the best way to control your COPD is to learn as much as you can about it.

COPD Stages

You may hear people talk about the old system, which staged COPD based on your FEV-1 score alone. There were four stages:

  • Stage 1 -- Mild -- FEV-1 ≥80%: You may have no symptoms. You might be short of breath when walking fast on level ground or climbing a slight hill.
  • Stage 2 -- Moderate -- FEV-1 50-79%: If you’re walking on level ground, you might have to stop every ­few minutes to catch your breath.
  • Stage 3 -- Severe -- FEV-1 30-49%: You may be too short of breath to leave the house. You might get breathless doing something as simple as dressing and undressing.
  • Stage 4 -- Very Severe -- FEV-1 ≤30%: You might have lung or heart failure. This can make it hard to catch your breath even when you’re resting. You might hear this called end-stage COPD.

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Can You Postpone Advanced or End-Stage COPD?

It depends on how advanced your COPD is and how well you respond to treatment. No two people are the same. But following these steps for a healthy lifestyle can help:

  • Don’t smoke. If you do, get help to quit.
  • Avoid unhealthy air. Keep away from dust, fumes, and smoke. Stay inside on bad air days.
  • Get a yearly flu shot. Ask your doctor if you need the pneumonia vaccine, too.
  • Eat healthy food. Talk to your doctor about how to keep your weight where it should be.
  • Keep moving. Make sure you get enough exercise.
WebMD Medical Reference Reviewed by Minesh Khatri, MD on July 17, 2019

Sources

SOURCES:

COPD Foundation: “What is COPD?” “Stages of 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.”

International Journal of Chronic Obstructive Pulmonary Disease: “Treatment of mild chronic obstructive pulmonary disease.”

Samaritan Healthcare & Hospice: “End-Stage COPD: COPD at the End of Life & What to Expect.”

American Lung Association: “COPD Lifestyle Changes.”

Pneumonologia i Alergologia Polska: “End stage chronic obstructive pulmonary disease.”

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