This COPD stages by GOLD guidelines calculator stratifies patients with chronic obstructive pulmonary disease according to the severity of dyspnea and FEV1 levels. You can read more about this lung disease and the GOLD initiative below the form.
How does this COPD stages by GOLD guidelines calculator work?
This is a health tool based on the Global Initiative on Obstructive Lung Disease classification of COPD severity. There are five stages numbered in Roman numerals with 0 being the least severe and stage IV being the most severe with predominant dyspnea and CRF:
■ Stage 0: no diagnosis but at risk with chronic cough and sputum production present but with normal spirometry.
■ Stage I: mild COPD characterized by mild airflow limitation (FEV1/FVC less than 70% but FEV1 80% or more than predicted).
■ Stage II: moderate COPD, indicated by worsening airflow limitation (FEV1 50-79% predicted) and usually progression of symptoms, with shortness of breath on exertion.
■ Stage III: severe COPD characterized by further worsening of airflow limitation (FEV1 30-50% predicted), increased shortness of breath, and repeated exacerbations.
■ Stage IV: very severe COPD with severe airflow limitation (FEV1 less than 30% predicted) or the presence of chronic respiratory failure.
Several studies have looked into the correlation between the GOLD stage and outcome prognostic in terms of survival and comorbidities. Other prognosis assessments that try to reflect disability in obstructive lung disease include the BODE Index and the modified MRC dyspnea scale.
The GOLD initiative aims at stratifying patient within the COPD stages and at creating a framework of in and out hospital management and strategy.
COPD medical considerations
This is a medical condition characterized by airflow obstruction that is partially irreversible, progressive and accompanied by an inflammatory response of the lungs. In the case of COPD, the obstruction is due to damage to the parenchyma and airway structures such as that is patients who already suffer from chronic bronchitis or emphysema.
In test terms, obstruction is defined as a reduced FEV1/FVC ratio (meaning forced expiratory volume in 1 second per forced vital capacity) to less than 0.7 combined with a FEV1 of less than 80%, in severe cases, FEV1 reaching less than 35% of the predicted normal.
The most common symptoms are dyspnea or breathlessness, cough and sputum production. Other signs relevant include a protruded chest, pale or cyanotic teguments due to hypoxia and determination proven acid base imbalance. The COPD also presents with wheezing, flapping tremor, effort intolerance and sometimes limb edema.
Chronic obstructive disease needs to be differentiated diagnostically from congestive heart failure, bronchopulmonary dysplasia, some forms of anemia, lung cancer or pneumoconiosis. The usual diagnosis uses assessments such as the BODE index and spirometry testing. Obstruction presence and degree is best evidenced through post-bronchodilator spirometry. Diagnostic means also include CT scanning, FBC (full blood count) for anemia or polycytemia as well as a BMI calculation in order to check the general health weight status.
Left untreated, COPD symptoms progress and lead not only to exacerbated dyspnea but also to chronic hypoxemia which evolves into pulmonary hypertension and ventricular hypertrophy. Other complications include atrial fibrillation, pneumothorax or secondary polycytemia.
1) Celli BR, Cote CG, Lareau SC, Meek PM. (2008) Predictors of Survival in COPD: more than just the FEV1. Respir Med; 102 Suppl 1:S27-35.
2) Marin JM, Cote CG, Diaz O, Lisboa C, Casanova C, Lopez MV, Carrizo SJ, Pinto-Plata V, Dordelly LJ, Nekach H, Celli BR. (2011) Prognostic assessment in COPD: health related quality of life and the BODE index. Respir Med; 105(6):916-21.
3) Sarioglu N, Hismiogullari AA, Bilen C, Erel F. (2006) Is the COPD assessment test (CAT) effective in demonstrating the systemic inflammation and other components in COPD? Rev Port Pneumol; pii: S2173-5115(15)00165-7.15 Nov, 2015