Overview of the Four Stages of COPD

The grading system helps identify the best treatment options

Doctor listening to patient's cough
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If you have been diagnosed with chronic obstructive pulmonary disease (COPD), the first thing you’ll likely want to know is what happens next.

As a progressive illness, COPD is characterized by stages of the disease that tell us what to expect at that moment in time. For this, doctors will refer to the Global Initiative for Chronic Obstructive Lung Disease ( GOLD) grading system which divides disease progression into four distinct stages.

The grading is determined using a simple, in-office spirometry test which can assess your lung capacity as well as the strength of your inhalation and exhalation. The determination of a GOLD grading helps doctor formulate a treatment plan appropriate to your stage of the disease.

Grade 1: Mild COPD

With grade 1 COPD, people will have some airflow limitation but will likely be unaware of it. In many cases, there will either be no symptoms of disease or the symptoms will be so minor as to be attributed to other causes. If present, symptoms can include a persistent cough with the visible production of sputum (a mixture of saliva and mucus). Because of the low-grade symptoms, people at this stage will rarely seek treatment.

Grade 2: Moderate COPD

With grade 2 COPD, airflow limitation begins to worsen, and the symptoms of COPD become more apparent. They can include a persistent cough, an increased production of sputum, and a shortness of breath upon minor exertion.

This is typically the stage when most people seek treatment.

Grade 3: Severe COPD

With grade 3 COPD, the restriction and/or obstruction of the airway passages is evident. People will experience a worsening of acute symptoms (known as COPD exacerbation) as well as an increased frequency and severity of coughing.

Not only will a person have less tolerance to physical activity, there will be greater fatigue and chest discomfort.

Grade 4: Very Severe COPD

With grade 4 COPD, a person’s quality of life will be profoundly impaired with symptoms ranging from serious to life-threatening. The risk of respiratory failure is high at grade 4 disease and may lead to complications in the heart (including a potentially fatal disorder called cor pulmonale).

How GOLD Grading Is Performed

Spirometry is the primary tool for evaluating the COPD grade. It looks specifically at four key measures of lung function, namely:

Together, these four measures not only tell how much damage has been done to the lungs but the ways in which you can improve your long-term outcomes should you have COPD.

Changing the Outcome of Your Disease

The GOLD grading system is only meant as a guideline to formulate the best course of action for your stage of the disease.

While it can be predictive of outcomes, it doesn’t mean that these outcomes are set in stone.

There are things you can definitely do to slow or even reverse some of the progressive symptoms of COPD. Chief among them is to quit smoking. Without removing cigarettes from your life, there is little you can do to mitigate the persistent damage smoking can do day in and day out.

By contrast, smoking cessation improves both the survival time and quality of life for people living with COPD. Proper nutrition and daily exercise are also key.

Don’t let the stage of disease stop you from embracing a healthier lifestyle.

You and you alone have an ability to "change the grade" if living with COPD.


Global Initiative for Obstructive Lung Disease. Pocket Guide to COPD Diagnosis, Management, and Prevention (2017 Report).