What Are the Four Stages of COPD?

Nick Rosen, MD
Medically reviewed by Nick Rosen, MDJuly 7th, 2021

What Are the Four Stages of COPD?

Chronic obstructive pulmonary disease (COPD) describes a collection of progressive diseases that cause inflammation and damage to the lungs. It’s most commonly the result of cigarette smoking, but can also be caused by environmental factors such as air pollution and exposure to chemicals, dust, and fumes.

The GOLD System

In 2001, the World Health Organization (WHO) and the National Heart, Lung, and Blood Institute came together to develop the Global Initiative for Chronic Obstructive Lung Disease (GOLD), which is a guideline for classifying and treating COPD.

Based on the GOLD system, there are four stages of COPD—mild, moderate, severe, and very severe—and to classify which stage a patient is in, a doctor will conduct a pulmonary function test using an apparatus called a spirometer. The spirometer measures forced vital capacity (FVC), which is how much air a person can exhale after taking a deep breath, as well as forced expiratory volume (FEV-1), which is how much air a person can exhale in one second. The ratio of these two measurements determines the stage of COPD:


Patients in the first stage of COPD may not experience any symptoms. At most, they may feel a little breathless from time to time and/or have a cough that produces excessive phlegm. Their FEV-1 number registers at 80% or more of normal lung capacity. During this stage, doctors typically recommend patients make lifestyle changes, such as quitting smoking, eating healthier meals, and getting regular exercise. Receiving flu and pneumonia vaccines is also a good idea, as these illnesses can exacerbate symptoms.

GOLD 2: Moderate COPD

In the second stage of COPD, a patient’s FEV-1 number registers between 50% and 79% of normal lung capacity. Here, symptoms become more pronounced, such as:

  • A chronic cough with mucus
  • Shortness of breath, even during mild activity
  • Wheezing
  • Fatigue
  • Difficulty sleeping

Patients in this stage may be prescribed a long-acting inhaler and should start pulmonary rehabilitation, a training program for COPD patients to learn more about their condition and how to manage their symptoms.

GOLD 3: Severe COPD

In this stage, FEV-1 registers between 30% and 49% of normal lung capacity. Symptoms will worsen, especially coughing and shortness of breath, and patients may also experience ankle swelling, chest tightness, frequent colds, difficulty taking deep breaths, and wheezing during routine tasks. At this point, many patients start supplementary oxygen and undergo more frequent check-ups to examine their lung capacity.

GOLD 4: Very Severe COPD

This is the final stage of COPD and it occurs when FEV-1 registers less than 30% of normal lung capacity. At this point, patients may be at risk for lung or heart failure and often experience low blood oxygen levels. Treatment options in this stage of COPD may include surgery, such as a lung transplant, bullectomy, or lung volume reduction.

ABCD Assessment Tools

In 2011, GOLD amended its staging system to include the

ABCD assessment tool, which incorporates patient-reported symptoms and a patient’s history of exacerbations to provide much more individualized treatment recommendations for how to reduce COPD severity. Now, COPD can be diagnosed by stage and then further classified into groups:

  • Group A – A patient with low symptom severity and at low risk for COPD exacerbations
  • Group B – A patient with high symptom severity and at low risk for COPD exacerbations
  • Group C – A patient with low symptom severity and at high risk for COPD exacerbations
  • Group D – A patient with high symptom severity and at high risk for COPD exacerbations

At-Home COPD Treatment

COPD is a condition characterized by reduced lung function, which means even simple activities like visiting your doctor’s office can be an arduous task. DispatchHealth offers at-home treatment for

COPD exacerbations from highly experienced healthcare professionals. After you request a visit, a DispatchHealth medical team will arrive at your doorstep to treat your symptoms and help you feel better. We’re happy to work with your primary care physician to coordinate follow-up care and your pharmacy to request necessary prescriptions, too.

Get in touch with DispatchHealth today by giving us a call, using our app, or contacting us through our website.

For life-threatening and time-sensitive injuries and illnesses, call 911 or go to the nearest emergency room. DispatchHealth shouldn’t be used in a life-threatening emergency and doesn’t replace a primary care provider.


DispatchHealth relies only on authoritative sources, including medical associations, research institutions, and peer-reviewed medical studies.

Sources referenced in this article:

  1. https://goldcopd.org/gold-reports/
  2. https://www.medicinenet.com/what_are_the_four_stages_of_copd/article.htm
  3. https://gaapp.org/copd/diagnosis/four-stages-of-copd/.
  4. https://www.cureus.com/articles/20508-global-initiative-for-chronic-obstructive-lung-disease-the-changes-made
  5. https://www.healthline.com/health/copd/what-are-the-4-stages-of-copd
The DispatchHealth blog provides tips, tricks and advice for improving lives through convenient, comfortable healthcare.

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