Table of ContentsView AllTable of ContentsFour Stages of COPDStage I: EarlyStage II: ModerateStage III: SevereStage IV: Very Severe
Table of ContentsView All
View All
Table of Contents
Four Stages of COPD
Stage I: Early
Stage II: Moderate
Stage III: Severe
Stage IV: Very Severe
Chronic obstructive pulmonary disease (COPD) is a long-term (chronic) condition. COPD is described according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) system using four stages. The goals of the GOLD system are to increase awareness of COPD and lower the morbidity (illness from a disease) and mortality rate (death from a disease).
Verywell / Ellen Lindner
The Four GOLD Stages of COPD
People with COPD develop lung damage fromemphysemaand long-term (chronic)bronchitis. The disease keeps the lungs from functioning normally. COPD is not just a single disease entity, but rather, a continuum of symptoms that begin with mild symptoms, progressing to a very severe stage.
The GOLD system aims to classify the severity of the disease based on symptoms and lung function, as well as the prevalence of flare-ups.
The stages of COPD include:
Each stage can involve various symptoms and requires different diagnostic parameters. Usually, a different treatment plan will be initiated as a person’s COPD progresses from one stage to the next.
Some symptoms and treatment modalities overlap from one stage to another, but the symptoms continue to worsen with the progression of the disease, from stage I to stage IV. Identifying the four stages of COPD enables healthcare providers to track a person’s progress, identify the severity of the disease (at each stage) as well as optimize treatment for the condition.
Chronic Obstructive Pulmonary Disease (COPD)
Stage I: Early Stage COPD
During the early stages of COPD an abnormal inflammatory response is present in the lungs, there is an obstruction of normal airflow through the lung’s airways, and there’s an abnormal pulmonary (lung) and systemic (throughout the entire body) immune response to long-term noxious particle exposure (usually from cigarette smoke).
Symptoms of Stage I COPD
Stage I is the stage in which COPD begins. It may be a very gradual process, taking years to develop. In this earliest stage, you may not have any symptoms at all.
The early stage of COPD may begin with an annoying cough that won’t subside. The cough can be productive (meaning it produces mucus) or it could be a dry cough.
Other symptoms that may be present during this initial stage of COPD include fatigue and/orshortness of breath(particularly when exerting one’s self). During this stage, many people assume that they have allergies, or are simply prone to catching colds.
Early diagnosis and intervention can provide an opportunity for the most effective COPD treatment, leading to better outcomes.
If you have breathing problems, it’s important to consult with your healthcare provider, particularly If you have been a smoker or you have worked (or lived) in an environment that has poor air quality.
Diagnosis of Stage I COPD
There are two primary tests that your healthcare provider will most likely perform to diagnose COPD. These include a physical examination and a spirometry test.
Aspirometry testinvolves deep breathing and blowing out into a tube connected to a meter that measures the pressure of airflow, called a spirometer. This test measures how well the lungs are functioning.
In stage I, the spirometry reading is equal to or below 80%forced expiratory volume (FEV1)in one second (of normal breathing/lung capacity) with moderate airflow limitation.
Other tests for COPD may include:
Diagnosis of COPD
Management of Stage I COPD
The most important (and effective) measure to take during the initial stage of COPD is to stop smoking if you are a smoker. If you live or work with a smoker, it’s important to avoid secondhand smoke as well. Other preventative measures for COPD may include:
Smoking Cessation During Stage I COPD
This group was categorized as GOLD stage 0 (at risk for COPD). In fact, 42% of those in the study who were smokers, considered at stage 0, showed radiological (X-rays) evidence of emphysema and airway disease. The study authors wrote, “Smoking cessation is the most effective intervention for preventing COPD and slowing disease progression.”
Marijuana Smoking and Lung Disease
Treatment for Stage I COPD
Medical treatment for the early stage of COPD may include an inhaler, such as ashort-acting bronchodilatorto help open the airways and ease breathing problems. Regularflu shotsto help strengthen the immune system and protect your body against respiratory infections that may exacerbate symptoms of COPD.
Emphysema vs. COPD: Similarities and Differences
Stage II: Moderate Stage COPD
During the second stage of COPD, the condition begins to impact life on a day to day basis, adversely affecting a person’s activity level and overall health.
Symptoms of Stage II COPD
Symptoms that are commonly present during stage II COPD include:
Stage II COPD is usually when people seek medical advice.
Diagnosis of Stage II COPD
Your healthcare provider will diagnose stage II COPD if your spirometry test measures between 50% to 79% forced expiratory volume (FEV1) in one second. TheFEV1 readingis the measurement of the lung’s ability to expire air.
Management of Stage II COPD
The pulmonary rehab program includes:
Treatment of Stage II COPD
Medical/pharmacological treatment for stage II COPD may include long-acting inhalers/bronchodilators.
COPD Treatment Guide
Stage III: Severe COPD
A person with stage III COPD will begin to experience symptoms that are more severe; these include:
Diagnosis of Stage III COPD
Diagnosis of stage III COPD is made when the lungs are around 30% to 50% capacity of their normal functioning ability. Your healthcare provider will diagnose stage III COPD if your spirometry test measures between 30% to 49% forced expiratory volume (FEV1) in one second.
Management of Stage III COPD
Although symptoms are severe at this stage, it’s just as important (and perhaps even more so) to stay active as with earlier stages of the disease. As before, staying on a healthy diet, exercising (with your healthcare provider’s approval), and avoiding smoking and environmental pollutants is important.
Treatment for Stage III COPD
Frequent checkups may be needed to test your pulmonary function and evaluate your response to medications Your healthcare provider may prescribe a steroid inhaler (to help decrease inflammation in the lungs)
Supplemental oxygen therapy may be ordered (note, oxygen therapy is not necessarily ordered during a specific stage of COPD, but, rather, it will be prescribed according to your symptoms. Most often, oxygen is prescribed for those with resting hypoxia (low oxygen levels when resting).
It can also be prescribed during periods of exacerbation, but some research evidence shows that oxygen therapy can be both harmful and helpful for COPD flare ups.Be sure to talk to your healthcare provider if you have questions about oxygen therapy.
When to Consider Oxygen Therapy for COPD
Stage IV: Very Severe COPD
This, in turn, impacts other organs, such as the heart and thepulmonary artery. The heart must work harder to pump the blood, which can result inheart disease. Water retention can occur as the heart becomes weaker and fluid may pool, causing swelling in the lower extremities (the feet, legs and ankles).
Symptoms of Stage IV COPD
During the final stage of COPD, the condition starts to seriously impact every activity a person engages in. Also, in this stage, shortness of breath is often present, even when a person is resting. When the blood oxygen level is low, while a person is inactive, this is referred to as restinghypoxia.
The symptoms of stage IV may involve all the symptoms from the other stages of COPD, but they worsen. For example:
Exacerbation episodesare more frequent, can be more severe, and can be fatal. Shortness of breath is so severe that it may impact the body’s circulation, affecting the heart due to lack of oxygen and proper airflow (this can result in cardiovascular complications).
Morning Headaches
Additional symptoms may include;
Diagnosis of Stage IV COPD
In stage IV COPD, the lungs are only functioning at 30% (or less) of normal capacity. Your healthcare provider will diagnose stage IV COPD if your spirometry test measures less than 30% of forced expiratory volume (FEV1) in one second.
Management of Stage IV COPD
The management of stage IV COPD normally remains the same as during stage III. It’s important to continue to stay as active for as possible, quit smoking or if you have already quit, stay off of cigarettes, e-cigarettes, or other smoking apparatus. Don’t forget the old adage, “You’re always a cigarette away from a pack per day."
Stay on your diet and continue to participate in your pulmonary rehabilitation groups/program. You may need to make adjustments.
Treatment Of Stage IV COPD
Treatment for stage IV COPD may include:
Surgical treatment may include:
A Word From Verywell
You may hear stage IV COPD referred to as “end stage chronic pulmonary obstructive disease.” But it’s important to note that many people with COPD live for years, particularly when following the advice of their healthcare provider and maintaining their treatment plan regarding lifestyle changes.
Another key factor is keeping a positive attitude, which can go very far in helping a person cope with any chronic disease. With good medical treatment—even if COPD is in the severe stage—it doesn’t necessarily have to be the driving force in your longevity.
Stick with your healthcare team’s plan, respond promptly to changes in symptoms (such as when flare-ups occur) and engage in some positive activities that you enjoy.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Global Initiative for Chronic Obstructive Pulmonary Disease.Global Strategy for Prevention, Diagnosis and Management of COPD.The Pulmonary Education And Research Foundation.The four stages of COPD, explained.Sun Y, Zhou J.New insights into early intervention of chronic obstructive pulmonary disease with mild airflow limitation.Int J Chron Obstruct Pulmon Dis. 2019;14:1119-1125. doi:10.2147/COPD.S205382The American Lung Association.The basics of pulmonary rehab.COPD.net.Morning headaches?Oh JY, Sin DD.Lung inflammation in COPD: Why does it matter?.F1000 Med Rep. 2012;4:23. doi:10.3410/M4-23Informed Health.org.Chronic obstructive pulmonary disease (COPD): Overview.Bennett S, Bruton A, Barney A, Havelock T, Bennett M.The relationship between crackle characteristics and airway morphology in COPD.Respir Care. 2015;60(3):412-21. doi:10.4187/respcare.03543Additional ReadingAnzueto A, Calverley P, deGuia T, et al.Global initiative for chronic obstructive lung disease. World Health Organization.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Global Initiative for Chronic Obstructive Pulmonary Disease.Global Strategy for Prevention, Diagnosis and Management of COPD.The Pulmonary Education And Research Foundation.The four stages of COPD, explained.Sun Y, Zhou J.New insights into early intervention of chronic obstructive pulmonary disease with mild airflow limitation.Int J Chron Obstruct Pulmon Dis. 2019;14:1119-1125. doi:10.2147/COPD.S205382The American Lung Association.The basics of pulmonary rehab.COPD.net.Morning headaches?Oh JY, Sin DD.Lung inflammation in COPD: Why does it matter?.F1000 Med Rep. 2012;4:23. doi:10.3410/M4-23Informed Health.org.Chronic obstructive pulmonary disease (COPD): Overview.Bennett S, Bruton A, Barney A, Havelock T, Bennett M.The relationship between crackle characteristics and airway morphology in COPD.Respir Care. 2015;60(3):412-21. doi:10.4187/respcare.03543Additional ReadingAnzueto A, Calverley P, deGuia T, et al.Global initiative for chronic obstructive lung disease. World Health Organization.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Global Initiative for Chronic Obstructive Pulmonary Disease.Global Strategy for Prevention, Diagnosis and Management of COPD.The Pulmonary Education And Research Foundation.The four stages of COPD, explained.Sun Y, Zhou J.New insights into early intervention of chronic obstructive pulmonary disease with mild airflow limitation.Int J Chron Obstruct Pulmon Dis. 2019;14:1119-1125. doi:10.2147/COPD.S205382The American Lung Association.The basics of pulmonary rehab.COPD.net.Morning headaches?Oh JY, Sin DD.Lung inflammation in COPD: Why does it matter?.F1000 Med Rep. 2012;4:23. doi:10.3410/M4-23Informed Health.org.Chronic obstructive pulmonary disease (COPD): Overview.Bennett S, Bruton A, Barney A, Havelock T, Bennett M.The relationship between crackle characteristics and airway morphology in COPD.Respir Care. 2015;60(3):412-21. doi:10.4187/respcare.03543
Global Initiative for Chronic Obstructive Pulmonary Disease.Global Strategy for Prevention, Diagnosis and Management of COPD.
The Pulmonary Education And Research Foundation.The four stages of COPD, explained.
Sun Y, Zhou J.New insights into early intervention of chronic obstructive pulmonary disease with mild airflow limitation.Int J Chron Obstruct Pulmon Dis. 2019;14:1119-1125. doi:10.2147/COPD.S205382
The American Lung Association.The basics of pulmonary rehab.
COPD.net.Morning headaches?
Oh JY, Sin DD.Lung inflammation in COPD: Why does it matter?.F1000 Med Rep. 2012;4:23. doi:10.3410/M4-23
Informed Health.org.Chronic obstructive pulmonary disease (COPD): Overview.
Bennett S, Bruton A, Barney A, Havelock T, Bennett M.The relationship between crackle characteristics and airway morphology in COPD.Respir Care. 2015;60(3):412-21. doi:10.4187/respcare.03543
Anzueto A, Calverley P, deGuia T, et al.Global initiative for chronic obstructive lung disease. World Health Organization.
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