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Stages of COPD

The basic "standard" for evaluating the severity of COPD has primarily been spirometry, also known as the Pulmonary Function Test (PFT). 

However, functional  dyspnea, body mass index (BMI), and  FEV1 from Spirometry, when evaluated collectively, offer better insight into outcomes such as survival.  Most times, the spirometry results are the only referenced statistics.

Spirometric Classification
    
The normal lung function, when measured with Spirometry, diminishes approximately 5% every 10 years after age 35 years old.  Therefore, it is rare for a person over 35 to have a 100%   In addition, the normal values for the FVC and FEV (2 of the measurements in a pulmonary function test) vary depending on age, height, sex and race.  The numbers are higher for:

  • 35 years old vs 65 years old
  • Taller than shorter builds
  • Men than women
  • Caucasian than most other races.

 The number used (FEV1) is a percent of the average expected of someone of your height, age, sex and race.   It is expressed as a percent of predicted.  Any number over 80% is considered normal

STAGE

 

Symptoms

Pulmonary Function Tests (PFT) with an FEV1 result of:

STAGE I 

mild

Often minimal shortness of breath with or without cough and/or sputum. Usually goes unrecognized that lung function is abnormal

>  80% of predicted

STAGE II

moderate

Often moderate or severe shortness of breath on exertion, with or without cough, sputum or dyspnea.  Often the first stage at which medical attention is sought due to chronic respiratory symptoms or an exacerbation

50-80%
of predicted

STAGE III

severe

more severe shortness of breath,  with or without cough, sputum or dyspnea - often with repeated exacerbations which usually impact quality of life,  reduced exercise capacity, fatigue

30 50%
of predicted

STAGE IV

very severe

appreciably impaired quality of life due to shortness of breath - possible exacerbations which may even be life threatening at times 

Less than 30% of predicted  -
or less than 50% with chronic respiratory
failure

The above chart is based in part on the Global Initiative for Chronic Obstructive Lung Disease.

Functional dyspnea
As assessed by the Medical Research Council dyspnea scale.

0: not troubled with breathlessness except with strenuous exercise.
1: troubled by shortness of breath when hurrying or walking up a slight hill.
2: walks slower than people of the same age due to breathlessness or has to  stop for breath when walking at own pace on the level.
3: stops for breath after walking ~100 m or after a few minutes on the level.
4: too breathless to leave the house or breathless when dressing or undressing.

BMI is easily obtained by dividing the weight (in kg) over the height (in m).  Values less than 21 kgm-2 are associated with increased mortality.

Note: The words dyspnea and dyspnoea are often interchanged.

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Last modified:
02/06/2013
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