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What are the 4 stages of COPD?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Oct 25, 2021.

Official answer


COPD is now classified using grades, not stages. Grades of COPD are ranked from 1 to 4, ranging from mild to a very severe grade of lung disease based on your results from a breathing test called spirometry. Your healthcare provider may also place you into a group (A to D) based on your current symptoms and your chances for flare-ups and hospitalizations.

"Staging" of COPD used to only rely on objective breathing tests like FEV1 and classified disease from mild to severe. Doctors now consider additional factors such as your symptom severity and number of flare-ups. Taking all of these factors into consideration can help your doctor to better guide your treatment.

These grades and groups are based on the 2021 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines, a commonly used tool doctors use to classify and treat chronic obstructive pulmonary disease (COPD).

COPD grading

Your doctor will use a spirometry test as one tool to determine how well your lungs are working. During spirometry, you breathe into a mouthpiece on a special machine. Before you perform the test, you may receive a dose of a short-acting bronchodilator like albuterol. These simple tests are usually performed in the doctor's office and measure how much air you inhale, how much you exhale and how quickly you exhale.

Spirometry measures your Forced Expiratory Volume in 1 second (FEV1) and Forced Vital Capacity (FVC), objective breathing tests your doctor uses to help diagnose COPD. FEV1 measures the amount of air you can breathe out from your lungs in one second after taking a deep breath in. Forced Vital Capacity (FVC) is the total amount of air exhaled during FEV.

Spirometry grade classification of airflow limitation severity in patients with FEV1/FVC <0.70:

  • GOLD 1: (mild): FEV1 ≥ 80% predicted
  • GOLD 2 (moderate): 50% ≤ FEV1 < 80% predicted
  • GOLD 3 (severe): 30% ≤ FEV1 < 50% predicted
  • GOLD 4 (very severe): FEV1 < 30% predicted

These numbers help your doctor understand how severe your condition is but may not fully explain your condition. You may also fill out questionnaires to help your doctor understand the impact of your breathing symptoms on your lifestyle and daily activities, your frequency of COPD flare-ups, what treatments you have used in the past, and your other medical conditions.

COPD groups

The group that you may be placed in is determined from your current symptoms and your chances for flare-ups (exacerbations) and hospitalizations. For example, Groups A and may be at lower risk for flare-ups with fewer symptoms, while Groups D is at higher risk for flare-ups, with more symptoms. During a flare-up, you may need a change in drug therapy to control your symptoms.

  • Group A: low risk (0-1 flare-ups per year that did not not require hospitalization) and fewer symptoms
  • Group B: low risk (0-1 flare-ups per year that did not not require hospitalization) and more symptoms
  • Group C: high risk (at least 2 flare-ups per year, or at least one that required hospitalization) and fewer symptoms
  • Group D: high risk (at least 2 flare-ups per year, or at least one that required hospitalization), and more symptoms.

For example, a patient classified as "Grade 4, Group D" would be at a very severe level of airflow limitation based on FEV1 <30 and being in a high risk group for flare-ups with more pronounced symptoms.

At what age do COPD symptoms start?

Symptoms of COPD due to smoking tend to begin at age 50 or 60 and will worsen unless you stop smoking. COPD cannot be cured but there are medicines to help control symptoms.

Learn More: COPD: Could You Be at Risk?

Common symptoms of COPD include:

  • morning cough, with mucus, which may worsen to a persistent cough
  • wheezing, shortness of breath, barrel-shaped chest
  • chest tightness, lung infections
  • fatigue, weight loss
  • bluish skin tint due to lack of oxygen
  • eventual heart failure

Chronic obstructive pulmonary disease (COPD) is a group of lung disorders that damage the lungs, block airflow, and make breathing more difficult over time. Most people who have COPD have both emphysema and chronic bronchitis; therefore, the more broad term COPD is used.

  • In emphysema, the walls between the air sacs in the lungs are damaged. They lose their shape, become larger, and can fill with mucus.
  • In chronic bronchitis, the lining of the airways is irritated and inflamed and also thickens with mucus.
  • In both instances, coughing is common and breathing becomes difficult.

COPD is not reversible, but medications can help reduce symptoms. It is also very important to quit smoking, if you smoke. Talk with your healthcare provider about group programs or medicines to help you quit.

Related: List of Common COPD Medicines


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