II. Background: Three different staging systems

  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD, pharma supported)
  2. American Thoracic Society (ATS) and European Respiratory Society (ERS)
  3. British Thoracic Society (BTS)

III. Staging: GOLD Spirometric Assessment

  1. Post-Bronchodilator FEV1 to FVC ratio: >0.7
    1. Stage 0
      1. At risk (ATS/ERS), Symptomatic Smokers
      2. FEV1 >79% of predicted
  2. Post-Bronchodilator FEV1 to FVC ratio <0.7
    1. Stage 1 - Mild (GOLD, ATS/ERS)
      1. FEV1 >79% of predicted
      2. Exacerbations per year: 0-1
      3. Gold Risk Group A or B (see below)
    2. Stage 2 - Moderate (GOLD, ATS/ERS), (BTS-Stage 1)
      1. FEV1 50-80% of predicted
      2. Exacerbations per year: 0-1
      3. Gold Risk Group A or B (see below)
    3. Stage 3 - Severe (GOLD, ATS/ERS), (BTS-Stage 2)
      1. FEV1 30-49% of predicted
      2. Exacerbations per year: 2 or more
      3. Gold Risk Group C or D (see below)
    4. Stage 4 - Very Severe (GOLD, ATS/ERS), (BTS-Stage 3)
      1. FEV1 <30% of predicted
      2. Exacerbations per year: 2 or more
      3. Gold Risk Group C or D (see below)

IV. Grading: GOLD Combined Assessment (Spirometry and symptom score)

  1. Risk Group A (low risk, fewer symptoms)
    1. Gold Stage 1 or 2
    2. Exacerbations per year: 0-1
    3. mMRC Score: 0 or 1
    4. COPD Assessment Test: <10
  2. Risk Group B (low risk, more symptoms)
    1. Gold Stage 1 or 2
    2. Exacerbations per year: 0-1
    3. mMRC Score: 2 or more
    4. COPD Assessment Test: 10 or more
  3. Risk Group C (high risk, fewer symptoms)
    1. Gold Stage 3 or 4
    2. Exacerbations per year: 2 or more
    3. mMRC Score: 0 or 1
    4. COPD Assessment Test: <10
  4. Risk Group D (high risk, more symptoms)
    1. Gold Stage 3 or 4
    2. Exacerbations per year: 2 or more
    3. mMRC Score: 2 or more
    4. COPD Assessment Test: 10 or more

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