COPD Stages
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 strategy recognizes the importance of other features of COPD such as symptoms assessed by questionnaires (COPD Assessment Test [CAT], modified Medical Research Council test [mMRC]) or exacerbations but lung function remains an important tool to define the severity of your airflow limitation and helps guide your treatment with inhaled medications (bronchodilators).
GOLD stages in individuals with an FEV1/FVC ratio under 0.7 are
GOLD Stage 1 FEV1 % predicted ≥80% (mild)
GOLD Stage 2 80% < FEV1 ≥50% (moderate)
GOLD Stage 3 50% < FEV1 ≥30% (severe)
GOLD Stage 4 30% < FEV1 very severe airflow limitation
Since 2011 the COPD Foundation and global researchers have recognized that many features of COPD exist before the development of airflow limitation.
MILD COPD
• You may cough a lot. Sometimes you cough up mucus.
• You feel a little out of breath if you work hard or walk rapidly.
MODERATE COPD
• You may cough more, and you cough up mucus.
• You often feel out of breath if you work hard or walk rapidly.
• You may have trouble doing hard work or chores.
• You may take several weeks to recover from a cold or chest infection.
SEVERE OR VERY BAD COPD
• You may cough even more and cough up a lot of mucus.
• You have trouble breathing both day and night.
• You may take several weeks to recover from a cold or chest infection.
• You can no longer go to work or do chores around home.
• You cannot walk up stairs or across the room very well.
• You tire easily
Stages of COPD and Spirometric Classifications
Stage I: Mild COPD Mild airflow limitation (FEV1/FVC < 70%; FEV1 >
80% predicted) and sometimes, but not always,
chronic cough and sputum production.
At this stage, the individual may not be aware that
his or her lung function is abnormal.
Stage II: Moderate COPD Worsening airflow limitation (FEV1/FVC < 70%;
50% < FEV1 < 80% predicted), with shortness of
breath typically developing during exertion.
This is the stage at which patients typically seek
medical attention because of chronic respiratory
symptoms or an exacerbation of their disease.
Stage III: Severe COPD Further worsening of airflow limitation (FEV1/FVC <
70%; 30% < FEV1 < 50% predicted), greater
shortness of breath, reduced exercise capacity,
and repeated exacerbations which have an impact
on patients’ quality of life.
Stage IV: Very Severe COPD Severe airflow limitation (FEV1/FVC < 70%; FEV1 <
30% predicted) or FEV1 < 50% predicted plus
chronic respiratory failure. Patients may have Very
Severe (Stage IV) COPD even if the FEV1 is > 30%
predicted, whenever this complication is present.
At this stage, quality of life is very appreciably
impaired and exacerbations may be life threatening.
The CAT system
What is the CAT?
The CAT is a validated, short (8-item) and simple patient completed questionnaire, with
good discriminant properties, developed for use in routine clinical practice to measure
the health status of patients with COPD. Despite the small number of component
items, it covers a broad range of effects of COPD on patients’ health. Studies have
shown that it is responsive to change and to treatment.
CAT was developed to address the need for a simple-to-use tool which can measure
the effect of COPD on the patient’s health and enhance understanding between
patients and physicians of the disease’s impact, in order to manage patients optimally
and reduce the burden of disease as much as possible.
Who developed the CAT?
The CAT was developed by a multidisciplinary group of international experts who have
expertise in developing patient reported outcomes tools/questionnaires. The group
included pulmonary specialists, primary care physicians, experts in the development of
Patient Reported Outcome measures and representatives from patient bodies. Patients with COPD were integral to the development and validation of
the tool. The CAT development was commissioned and funded by GlaxoSmithKline
(GSK).
COPD Assessment Test
The COPD Assessment Test (CAT) is a questionnaire for people with Chronic Obstructive Pulmonary Disease (COPD). It is designed to measure the impact of COPD on a person’s life, and how this changes over time.
The results of the test should only be used in discussion with your healthcare professional to better manage your COPD.
The content of the CAT questionnaire has been driven by COPD patients.
Questions
I never cough 0 1 2 3 4 5 I cough all the time
I have no phlegm (mucus) in my chest at all 0 1 2 3 4 5 My chest is completely full of phlegm (mucus)
My chest does not feel tight at all 0 1 2 3 4 5 My chest feels very tight
When I walk up a hill or one flight of stairs I am not breathless 0 1 2 3 4 5 When I walk up a hill or one flight of stairs I am very breathless
I am not limited doing any activities at home 0 1 2 3 4 5 I am very limited doing activities at home
I am confident leaving my home despite my lung condition 0 1 2 3 4 5 I am not at all confident leaving my home because of my lung condition
I sleep soundly 0 1 2 3 4 5 I don’t sleep soundly because of my lung condition
I have lots of energy 0 1 2 3 4 5 I have no energy at all
modified Medical Research Council test [mMRC])
The MRC Scale can be used to measure dyspnoea in various conditions like COPD, Bronchial asthma, Restrictive disease, pulmonary fibrosis, occupational lung disease, various heart conditions such as heart failure.
It is a questionnaire in which patient has to understand the activity when he feels dyspnoea and based on that patient has to grade the dyspnoea. The MRC breathlessness scale comprises five statements that describe almost the entire range of respiratory disability from none (Grade 1) to almost complete incapacity (Grade 5). It can be self-administered by asking subjects to choose a phrase that best describes their condition, e.g. ‘I only get breathless with strenuous exertion’ (Grade 1) or ‘I am too breathless to leave the house’ (Grade 5). Alternatively, it can be administered by an interviewer with the statements framed as questions, e.g. ‘Are you short of breath when hurrying on the level or walking up a slight incline’ (Grade 2). The score is the number that best fits to the patient’s level of activity. All the questions relate to everyday activities and are generally easily understood by patients. A score can usually be obtained in a few seconds.
Based on various researcher it was found that MRC scale is valid and reliable tool to measure dsypnea in various condition. It also gives and idea about the functional status of the patient and predicts severity
1 Not troubled by breathlessness except on
strenuous exercise
2 Short of breath when hurrying on the level or
walking up a slight hill
3 Walks slower than most people on the level,
stops after a mile or so, or stops after 15
minutes walking at own pace
4 Stops for breath after walking about 100 yds or
after a few minutes on level ground
5 Too breathless to leave the house, or breathless
when undressing