It’s estimated that around 12 million Americans have chronic obstructive pulmonary disease (COPD) (either in the form of chronic bronchitis or emphysema) and that another 12 million have the disease but haven’t been diagnosed. To establish the severity of a patient’s COPD and decide on the course of treatment, doctors will need to run tests to establish what stage the disease is at.
Doctors will usually perform a pulmonary function test using a spirometry device which measures the amount of air you breathe in and out. In addition, two other tests are used to determine the severity of the disease: the GOLD system and the BODE index.
According to the Lung Institute, the Gold system (Global initiative for Obstructive Lung Disease) uses the results of a forced expiratory volume (FEV1) test to determine how much air the patient can expel from their lungs in a single second.
The Gold system breaks COPD down into four different stages depending on the FEV1 results.
- Very Mild COPD (Stage 1): FEV1 result 80 percent or more of a healthy person which causes slight airflow limitation
- Moderate COPD (Stage 2): FEV1 result of 50 percent to 80 percent of a healthy person. This is often the stage where people begin to seek medical help for symptoms such as wheezing, coughing and shortness of breath..
- Severe COPD (Stage 3): FEV1 result of 30 percent to 50 percent of a healthy person. Patients will suffer worsening symptoms which will affect their quality of life.
- Very Severe COPD (Stage 4): FEV1 result of 30 percent or less of a healthy person and those with a slightly higher FEV1 score but low levels of blood oxygen. This is considered end-stage COPD where the disease has progressed to a point where lung function is severely limited and flare-ups could be life-threatening.
The BODE index for COPD staging also takes into account other aspects. BODE looks at Body Mass, Airflow Obstruction, Dyspnea, and Exercise Capacity. A patient’s weight (or BMI), FEV1 score, breathlessness and the six-minute walking test are all measured to determine the stage and the prognosis of the disease.
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