The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is a program created to raise awareness of COPD signs and symptoms and to boost COPD life expectancy. It was launched in collaborative effort between the National Heart, Lung, & Blood Institute, the National Institutes of Health, and the World Health Organization.
GOLD COPD guidelines are used to assess how severe a patient’s COPD is, and to establish his or her COPD prognosis. GOLD COPD also has guidelines for the use of spirometry in assessing COPD signs and symptoms.
A spirometer is a machine that measures how fast air is blown out of the lungs, as well as the total amount of air inhaled and exhaled—you simply take a deep breath in and then exhale as hard and as long as possible into a hose connected to the spirometer.
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The spirometer takes several types of measurements. Some common ones used for assessing COPD signs and symptoms are as follows:
- Forced vital capacity (FVC): The total amount of air that can forcibly be blown out after inhalation.
- Forced expiratory volume in 1 second (FEV1): The amount of air that can be blown out in one second.
- The ratio of FEV1 to FVC (FEV1/FVC): In healthy adults, this should be 75 to 80 percent.
- Peak expiratory flow (PEF): The speed of air moving out of the lungs at the beginning of an exhalation.
GOLD COPD standards recommend that people who are at high risk for COPD should have a spirometry test. Specifically, this includes people age 40 and who have a history of exposure to COPD risk factors, such as tobacco smoke; exposure to other kinds of smoke, or dusts and fumes (for example, you might have worked in a machine factory or grain mill); and have COPD signs and symptoms such as a chronic cough with mucus and/or phlegm.
GOLD COPD and COPD stages
People with COPD have a decrease in FEV1 (the amount of air that can be blown out in one second). As the disease gets worse, the FVC (the total amount of air that can be exhaled after inhalation) also deteriorates compared with people of the same age who have normal lung function.
In GOLD guidelines, COPD is divided into four stages: mild, moderate, severe, and very severe. These classifications are based on increasing severity of airflow restriction and symptoms. The spirometry reading for FEV1 is generally used to determine the severity classification, which can provide information as to your life expectancy with COPD.
- Stage 1 COPD: Mild COPD: Spirometry shows mild limitation in airflow. Chronic cough and sputum production may be present. At this stage, the person is often unaware of impaired lung function.
- Stage 2 COPD: Moderate COPD: Spirometry shows limitation in airflow that is worse than in mild COPD. Shortness of breath typically occurs with exertion. Cough and sputum production are more likely than in mild COPD. At this stage, the person may first become aware of a problem with breathing, and seek medical advice.
- Stage 3 COPD: Severe COPD: Airflow limitation becomes progressively worse. Shortness of breath will increase, even with even a small amount of exertion, and the person will likely feel fatigued. Quality of life often diminishes.
- Stage 4 COPD: Very severe COPD: Stage 4 COPD may also be known as end stage COPD. Airflow is severely compromised, and this may lead to heart problems, such as heart failure. Quality of life is markedly impaired. Exacerbations of the disease may be life-threatening.
Originally published in March 2016 and updated.