COPD Staging

Aka: COPD Staging, GOLD Combined Assessment

1. See Also
   1. COPD
   2. Emphysema
   3. Chronic Bronchitis
   4. COPD Management
   5. Acute Exacerbation of Chronic Bronchitis
   6. Antibiotic Use in COPD Exacerbation
   7. COPD Exacerbation Prevention
   8. COPD Action Plan
2. See Also
   1. mMRC Dyspnea Index
   2. COPD Assessment Test (CAT Tool)
   3. BODE Index
   4. Chronic Obstructive Pulmonary Disease
   5. Chronic Bronchitis
   6. Emphysema
   7. COPD Management
   8. Alpha-1-Antitrypsin Deficiency
   9. Acute Exacerbation of Chronic Bronchitis
3. Background: Three different staging systems
   1. Global Initiative for Chronic Obstructive Lung Disease (GOLD, pharma supported)
   2. American Thoracic Society (ATS) and European Respiratory Society (ERS)
   3. British Thoracic Society (BTS)
4. Staging: GOLD Spirometric Assessment
   1. Post-bronchodilator FEV1 to FVC Ratio: >0.7
      1. Stage 0
         1. At risk (ATS/ERS), Symptomatic Smokers
         2. FEV1 >79% of predicted
   2. Post-bronchodilator FEV1 to FVC Ratio <0.7
      1. Stage 1 - Mild (GOLD, ATS/ERS)
         1. FEV1 >79% of predicted
         2. Exacerbations per year: 0-1
         3. Gold Risk Group A or B (see below)
      2. Stage 2 - Moderate (GOLD, ATS/ERS), (BTS-Stage 1)
         1. FEV1 50-80% of predicted
         2. Exacerbations per year: 0-1
         3. Gold Risk Group A or B (see below)
      3. Stage 3 - Severe (GOLD, ATS/ERS), (BTS-Stage 2)
         1. FEV1 30-49% of predicted
         2. Exacerbations per year: 2 or more
         3. Gold Risk Group C or D (see below)
      4. Stage 4 - Very Severe (GOLD, ATS/ERS), (BTS-Stage 3)
         1. FEV1 <30% of predicted
         2. Exacerbations per year: 2 or more
         3. Gold Risk Group C or D (see below)
5. Grading: GOLD Combined Assessment (Spirometry and symptom score)
   1. Risk Group A (low risk, fewer symptoms)
      1. Gold Stage 1 or 2
      2. Exacerbations per year: 0-1
      3. mMRC Score: 0 or 1
      4. COPD Assessment Test: <10
   2. Risk Group B (low risk, more symptoms)
      1. Gold Stage 1 or 2
      2. Exacerbations per year: 0-1
      3. mMRC Score: 2 or more
      4. COPD Assessment Test: 10 or more
   3. Risk Group C (high risk, fewer symptoms)
      1. Gold Stage 3 or 4
      2. Exacerbations per year: 2 or more
      3. mMRC Score: 0 or 1
      4. COPD Assessment Test: <10
   4. Risk Group D (high risk, more symptoms)
      1. Gold Stage 3 or 4
      2. Exacerbations per year: 2 or more
      3. mMRC Score: 2 or more
      4. COPD Assessment Test: 10 or more
6. Resources
   1. GOLD Global Strategy
      1. http://goldcopd.org/global-strategy-diagnosis-management-prevention-copd-2016/
7. References
   1. Gentry (2017) Am Fam Physician 95(7): 433-41 [PubMed]