The official blog of the Lung Institute.
By Krystina Ostermeyer RN, BSN
If you’ve been told you have stage IV chronic obstructive pulmonary disease (COPD), you probably also know it’s also referred to as “end-stage COPD.” This is probably terrifying — but what exactly does this mean?
It helps to have an understanding of how the stages of COPD are tracked, what the stages mean, and a bit about the pathophysiology and prognosis of COPD, before you jump to conclusions.
How COPD Is Staged
The most common way to stage COPD is using the GOLD classification. GOLD is an acronym for Global Initiative for Obstructive Lung Disease, which is a collaborative effort between the National Institutes of Health (NIH) and the World Health Organization (WHO).
GOLD classification is a standard way to stage COPD based on your level of airflow. Airflow is measured during a pulmonary function test (PFT), which measures several things, but most importantly, it measures:
- Forced expiratory volume (FEV1): volume in a one-second exhalation, measured in liters.
- Forced vital capacity (FVC): total exhaled breath, measured in liters.
For people with normal breathing capacity, the FEV1 should be 70 percent of FVC. People with COPD have a FEV1 of less than 70 percent.
GOLD Staging of COPD
COPD GOLD stages use four stages; the higher the stage, the lower the FEV1 percentage. Staging is based on the value of the FEV1.
- Stage I: mild COPD; FEV1 greater than 80 percent normal
- Stage II: moderate COPD; FEV1 50 – 79 percent normal
- Stage III: severe COPD; FEV1 30 – 49 percent normal
- Stage IV: very severe COPD; FEV1 less than 30 percent normal or less than 50 percent normal with chronic respiratory failure present
Pathophysiology and Prognosis of COPD
COPD is caused by a combination of two different diseases: chronic bronchitis and emphysema. Emphysema causes the alveoli to lose elasticity, thus not expanding properly during respiration.
Bronchioles become inflamed, which causes excess mucus production, leading to bronchitis. When this becomes a persistent cycle, it causes COPD.
It is estimated that COPD affects about 24 million Americans — and a whopping 12 million of those are undiagnosed. Due to the chronic nature of COPD, it has no cure, but early treatment can help slow the progression.
Every person with COPD is different, which makes discussing prognosis difficult. If diagnosed early, people can live with COPD for many years. If undiagnosed and untreated, people tend to do poorly.
Why the Stages May Not Always Be Useful
The stages tell doctors one thing — how breathing is based on numbers. These numbers are helpful for treatment purposes, but they can do nothing in terms of predicting quality of life or COPD life expectancy.
The average person living with stage IV COPD typically has worse symptoms and a shortened lifespan. Average does not mean every person with stage IV COPD though.
There are other factors to consider when it comes to quality of life. For example, a person with stage IV COPD who is physically fit, does not have heart disease and is an ex-smoker may live longer than someone who has stage I COPD and is morbidly obese with heart disease and gets no exercise.
For this reason, “end-stage” COPD should be used when a person suffering from COPD is actually at the end of their life, not when their COPD progresses to stage IV COPD.
Author’s Information– Krystina is a practicing RN who also enjoys writing about health and wellness. She has a varied nursing background and is currently working as a diabetes educator. She lives in a small town with her husband and two-year-old son. You can find more of Krystina’s writing on NewLifeOutlook.