COPD-GOLD stages: therapies, symptoms and life expectancy

What are the GOLD stages?

With the Gold Stages, COPD is divided into 4 different levels of disease severity. GOLD stands for the Global Initiative for Chronic Obstructive Lung Disease [1]. This initiative was launched in 2001 to give the respective national guidelines a common structure.

Reports are now published annually, which also change the classification after major revisions. In 2011 the four GOLD stages, GOLD I-V, were redefined[2]. In addition, the letters A, B, C and D can be used to describe them more precisely. [3]

What exactly do the subdivisions into COPD stages mean?

The classification into GOLD stages 1, 2, 3 and 4 is based on the results of the lung function test. The letters A, B, C and D, on the other hand, describe how often the breathing situation deteriorates during the year and as how severe the patient’s respiratory distress or influence on everyday life is assessed.  

The numbers 1-4 are therefore based directly on the measurement of lung function, while the letters A-D rather describe how a patient experiences his COPD in everyday life.[1]

Doctors often use results from medically proven questionnaires such as the mMRC (Respiratory Distress Questionnaire) and the CAT (COPD Assessment Test) for subdivision A, B, C and D. For example, it asks you how often you cough, at what level of stress you feel breathlessness and how you feel restricted in your everyday life by the COPD. [4,5]

The treatment of COPD is based on symptoms and medical history.

Smoking and inhalation of pollutants causes the disease to progress more rapidly and patients to be placed in a worse stage more quickly. An acute and rapid deterioration of the respiratory situation is called exacerbation. Maybe you already read that in one of your doctor’s letters.

The pulmonary function test and the peak flow meter

As just described, the performance in pulmonary function determines the level at which you are classified. By the way, it is very important that you participate well. Otherwise, the results can only be evaluated to a limited extent, which can influence doctors‘ decisions regarding treatment. During this examination you will be asked to breathe deeply, hold your breath and then exhale as much as you can.

Important COPD values are:

  • Vital capacity: How many litres of air can be exhaled after maximum inhalation?
  • One second capacity: How many litres can be exhaled in the first second?

The so-called Tiffenau index (which is calculated from the one-second capacity divided by the vital capacity) describes the percentage of vital capacity that can be exhaled in the first second. This value reliably indicates how severe the obstruction of the respiratory tract by COPD is. [6]

Tiefenau Index is an important tool to identify the GOLD Stage of a patient
The Tiefenau Index is used to detect obstruction in COPD.

If the complaints reported by those affected also match a COPD, then a Tiffenau index below 70% is a decisive indication of the presence of a COPD. Prior to this, however, other possible clinical disease patterns must be ruled out.

If you have – absolutely seen – the one-second capacity of a healthy person (over 80%), you will be classified in GOLD I and thus have a COPD of slight grade. The further gradations work as follows[7]:

 

FEV1 Target value Severity according to FEV1
Greater than or equal to 80% COPD Gold Level I (slight)
Between 50% and 80% COPD Gold Level II (medium)
Between 30% and 49% COPD Gold Level III (serious)
Less than 30% COPD Gold Level IV (very serious)

Simple lung function tests can also be performed at home with so-called peak flow meters. These devices measure the maximum flow velocity during forced exhalation, i.e. how fast you can exhale air at maximum speed.

The peak flow provides an indication for monitoring the course of the disease. If you have a peak flow meter, you should use it daily if possible. In this way, a change can be noticed and counteracted at an early stage. [8]

How does the therapy change at which stage?

How COPD is treated depending on the stage of the disease is very different in each case and depends more on the symptoms (the letters A, B, C and D) and not so much on lung function (GOLD stages I, II, III or IV). [7]  

Basically, this indicates how well the disease and its symptoms (shortness of breath, cough, sputum) are kept under control by the treatment and thus also how well the previous therapy works.  

The mechanism used for COPD Gold Stages to put patients in groups
The division into groups is based on the number of deteriorations and the symptoms.

If you belong to group A, a bronchodilating spray is usually sufficient. There are sprays that are effective for a short time and those effective for longer. In some cases not even medication is needed.

Patients in group B receive a long-lasting spray that widens the bronchi. They may also be prescribed a combination of two different active ingredients.

In groups C and D – in patients with more frequent deterioration or severe respiratory distress – two classes of active substances are always used together. Nowadays they are often already contained in a combined spray.

Which drugs are used at which level?

The variety of names of drugs for COPD is quite colorful and new ones are constantly being added. You can divide them into a few groups that are used at the different GOLD stadiums and groups. [7,9]

If you belong to group A, you are initially treated with a bronchodilating, rapidly effective spray alone. [10]  

If the shortness of breath is more pronounced and you are classified in group B, you will receive a particularly long-acting bronchodilating spray in addition to the above-mentioned ones. [1, 7]

Combinations of the individual active ingredients are also practical and widely used. This table shows some examples of the active ingredients:[10]

Rapidly effective sprays Long lasting spray Combinations of ingredients
Fenoterol Formoterol Fenoterol und Ipratropiumbromid
Salbutamol Salmeterol Salbutamol und Ipratropiumbromid
Terbutalin Indacaterol Vilanterol und Umeclidiniumbromid
Vilanterol Indacaterol und Glycopyrroniumbromid
Olodaterol Olodaterol und Tiotropiumbromid
Tiotropiumbromid

With all the sprays you can easily lose the overview. The different sprays have to be used differently and the time at the lung doctor is not always sufficient to learn the technique correctly.

Inhalers can be very different – the right technique must be learned.

Therefore, many patients have difficulty using the sprays as prescribed. This can be a major problem, as the inhalers do not have their full effect if used incorrectly. [11] 

COPD overlaps with asthma quite often. Although asthma also leads to a narrowing of the respiratory tracts, it is treated differently. As a result, cortisone preparations such as budesonide and fluticasone may also be prescribed for inhalation.

How does life expectancy change with the GOLD stages?

Depending on the GOLD stages, life expectancy develops. It is clear:

 Patients who manage to stay at the lowest possible level through good treatment but also a healthy lifestyle have the best life expectancy.  

Even at an advanced level you can still enjoy a very high quality of life with the right lifestyle. [12] The most important measure for this is to stop smoking, but proper treatment with and without medication can also keep the progression of the disease in check and thus improve life expectancy[13].

The Kaia COPD medical app, which provides you with relaxation and movement exercises as well as much additional knowledge, is a good option for therapy without medication. As a person affected, it is therefore possible to influence your life expectancy.

How effective are therapies without medication?

In addition to the classical treatment methods of COPD, such as the above-mentioned drugs, non-drug approaches are also attracting increasing attention. [14]

The most efficient and thus most important measure in the fight against the often existing chronic bronchitis is smoking cessation. The symptoms of COPD are diminishing and the quality of life is increasing rapidly. In addition, life expectancy is extended for all gold stages of the COPD. [15]

Quitting smoking is the most effective way to slow down COPD.

The majority of COPD patients suffer from respiratory distress every day. It is therefore the most common symptom of COPD and can occur regardless of the severity of the disease. It also contributes to the classification into groups A, B, C and D, as we have described above.

Breathing gymnastics as a supporting measure

Breathing gymnastics and breathing exercises, which have been used since the 1950s, have been specially developed to alleviate shortness of breath. [16,17]

You may have heard of the forward leaning position, pursed lip breathing or diaphragm breathing, for example. Such breathing exercises are often taught in Germany in rehabilitation, respiratory physiotherapy or in lung sports and can help against complaints caused by shortness of breath – in other words, support patients of all stages in the improvement of one of their most frequent complaints. [18]

Breathing exercises also have other positive effects on the course of the disease: they are also used to relieve or strengthen the respiratory muscles, improve the coughing up of sputum, increase the mobility of the chest and improve gas exchange in the lungs. [19]

Breathing exercises (e.g. with the Kaia COPD App) help at all GOLD stages of COPD.

Modern methods such as computer-assisted breathing feedback devices or even alternative methods such as playing the didgeridoo or specific COPD singing exercises can also be part of the therapy. [19] So you can find out for yourself what is best for you.

 

Regardless of the gold level of COPD, experts agree: breathing exercises and training, for example in the context of lung rehabilitation, help all patients with symptoms caused by COPD. This improves shortness of breath, physical activity and quality of life. [20] The Kaia COPD medical app is also based on this concept, which enables you to effectively implement the best exercises and information about your lungs at home every day. You can test it directly here with a seven days tryout.

 

Important notice:

This article contains general information only and may not be used for self-diagnosis or self-treatment. It cannot replace a visit to the doctor.

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