COPD Severity

GOLD Stages

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials to raise awareness of Chronic Obstructive Pulmonary Disease (COPD) and to improve prevention and treatment of this lung disease for patients around the world.

• GOLD COPD Stages

  Their latest Spirometry Guide for Health Care Providers is available at www.goldcopd.org.

  Below is an extract from the 2011 revision. All stages described are only applicable when the ratio of FEV1/FVC is less than 70% after bronchdilator.

  Stage#	Stage	FEV1 range	Symptoms
  1	Mild	FEV1 ≥ 80% predicted	At this stage, the patient may not be aware that his/her lung function is abnormal.
  2	Moderate	50% ≤ FEV1 < 80% predicted	Symptoms usually progress at this stage with shortness of breath typically developing on exertion.
  3	Severe	30% ≤ FEV1 < 50% predicted	Shortness of breath typically worsens at this stage and often limits patients’ daily activities. Exacerbations are seen beginning at this stage.
  4	Very Severe	FEV1 < 30% predicted	At this stage, quality of life is very appreciably impaired and exacerbations may be life-threatening.

  In previous revisions stage 4 was defined as “FEV1 < 30% predicted OR FEV1 < 50% predicted plus chronic respiratory failure”.
  The practice of using Roman numerals for the stages is becoming less common.
  Predicted values for FEV1 and FVC are described on page FEV1&FVC.

  Respiratory failure occurs when the respiratory system fails in oxygenation and/or carbon dioxide (CO2) elimination. A simple, medically approved description is available at Patient.co.uk.

    

The Medical Research Council Breathlessness Scale

The MRC Breathlessness Scale quantifies the disability associated with breathlessness.  It is not a direct measure of breathlessness itself. Grades 1-2 identify situations where breathlessness should not occur and grades 3-5 are measures of exercise limitation. The scale may need sensitive interpretation: a patient who may be able to leave the house but not be able to walk a hundred yards is neither Grade 4 or Grade 5.  Notwithstanding this, over the years, the Scale has been found to be extremely useful .  It is easy to use in Primary Care situations when lung function testing may not be readily available.  The scores correlate well with the results of other breathlessness scales, lung function measurements {see the GOLD grades given above} and with direct measures of disability such as walking distance.

• Medical Research Council Breathlessness Scale

  Grade	Degree of breathlessness related to activities
  1	Not troubled by breathlessness except on strenuous exercise
  2	Short of breath when hurrying on the level or walking up a slight hill
  3	Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
  4	Stops for breath after walking about 100 yds or after a few minutes on level ground
  5	Too breathless to leave the house, or breathless when undressing