Chronic obstructive pulmonary disease (COPD) is a term used for describing a group of long-term lung conditions that cause breathing difficulties. Unfortunately, not only is COPD one of the most common causes of illness and death in the U.S. but all over the world too. To be more precise, it is the fourth leading cause of death.
Hence, to raise awareness of COPD and reduce the morbidity and mortality rate, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has made a classification of the four stages of COPD based on the symptoms, lung function, and flare-ups prevalence.
The Four GOLD Stages of COPD
- Early Stage
The early stage is actually the stage in which COPD first develops and may take up to a couple of years. Even though some patients may even not have any symptoms in the first stage, common symptoms include persistent cough, fatigue, and shortness of breath.
Luckily, early diagnosis can offer a chance for the most effective treatment. Namely, there are two tests for diagnosing COPD: a physical examination and a spirometry test used to check the performance of the lungs. Other tests may include CT scan, chest X-ray, Alpha-1-antitrypsin, etc.
And, once you are diagnosed with early-stage of COPD, you should stop smoking, increase physical activity, follow a healthy diet, and avoid air pollutants and strong chemicals. Plus, your doctor may prescribe an inhaler to ease breathing and taking regular flu shots to protect against infections.
- Moderate Stage
In the second stage of COPD, you will begin to notice that the condition affects your daily life. You may also notice the following symptoms: chronic cough, mild to severe fatigue, shortness of breath that makes even minor activities difficult, wheezing, sleep issues, slurred speech, confusion, and flare-ups (experiencing worse symptoms for a few days).
To be diagnosed with stage II COPD, your doctor will use the same tests: physical examination and spirometry, and advise you to start a pulmonary rehab program which consists of group support, physical activity, health and healthy diet education, symptoms management, breathing techniques, and smoking cessation program. Also, you may be given long-acting inhalers or bronchodilators.
- Severe Stage
As you can guess from the name, in the third stage of COPD a person will start to have severe symptoms like worsen cough and shortness of breath, frequent respiratory infections and flare-ups, rapid breathing, morning headaches, blue lips or nail beds, deep breathing and sleeping difficulties, swelling in the lower extremities, and mental confusion.Your doctor will diagnose you with the third stage of COPD if your lung capacity falls to 30% to 50% or if your spirometry test results are 30% to 49% FEV1 in a second.
In this stage, a patient must start with a pulmonary rehab program if they haven’t started yet. And, there’s also a need for frequent checkups to check lung function and response to medications. Common treatments for the severe stage of COPD include steroid inhaler and supplemental oxygen therapy.
- Very Severe Stage
During the final stage of COPD, the lungs aren’t able to provide the oxygen supply needed throughout the body which negatively impacts other organs like the heart and the pulmonary artery. Stage IV COPD is characterized by the same symptoms listed in the other stages, but they are remarkably worsened.
So, for instance, a person may experience shortness of breath or increased heart rate even when resting or have difficulties even with daily tasks like dressing. Furthermore, weight loss is also a common symptom in this stage, as well as flare-ups that require emergency hospitalization, crackles, barrel chest, chest pain, delirium, drowsiness, and depression.
The management recommendations remain the same as during the third stage and when it comes to treatment your doctor may prescribe a short-acting bronchodilator, a long-acting bronchodilator, or supplemental oxygen therapy. But, surgical treatments may also be included such as lung volume reduction surgery or a lung transplant.