Chronic obstructive pulmonary disease (COPD) is a chronic lung condition characterized by shortness of breath and a chronic cough. Although there’s no cure for this progressive lung disease, it can be managed (and its progression slowed) with the right steps and by working closely with your doctor.
COPD is classified into four stages: mild, moderate, severe, and very severe. To determine where your COPD falls on this spectrum, your doctor will take a careful history, evaluate your symptoms, may perform a few tests — including lung function tests, chest X-ray, or computerized tomography (CT) scan — and consider how often your COPD flares up.
Establishing the stage of your COPD helps your doctor decide on the best treatment plan to help you better manage your illness and your health.
What Are the COPD Stages and the GOLD System?
Pulmonologist Nikita Agrawal, MD, explains the stages of COPD and the GOLD System.
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What Is the GOLD Criteria System?
GOLD (global initiative for chronic obstructive lung disease) was first established in 2001 by the U.S. National Heart, Lung, and Blood Institute (NHLBI) and the World Health Organization (WHO).
Within the organization, a large panel of experts from around the world reviews the latest research in COPD and provides recommendations to doctors that are regularly updated. The GOLD Criteria is the standardized way that COPD is assessed and classified and includes recommendations on how doctors should manage different stages of COPD.
The criteria are based on three factors.
Lung Function
The objective measure used to establish the diagnosis of COPD is a pulmonary function test, specifically spirometry, says Philip Diaz, MD, a pulmonologist and a critical care doctor at the Ohio State University Wexner Medical Center in Columbus. “In a spirometry test, you take a deep breath and blow it out hard and fast. By doing this, we can see how much air you have that you can get out as well as how fast you can get it out,” says Dr. Diaz.
This is called FEV, which stands for forced expiratory volume. FEV1 is how much air you can force from your lungs in one second. Your doctor will compare your FEV1 score with what the expected score would be for a person of similar age, sex, and height, without COPD.
Based on the FEV1 score, your doctor can get an idea of how severe the airflow obstruction is, says Diaz. “That’s the ‘O’ in COPD, and that’s how we quantitate the obstruction.” The results often correlate with the degree of symptoms. And Diaz notes that the FEV1 score can also have some prognostic implications.
Symptom Severity
Doctors also consider symptoms when evaluating a person’s COPD because pulmonary function isn’t everything, says Diaz. “I certainly see people with the same level of pulmonary function abnormality, and some do quite well, while others can barely walk across the room, so there are other factors at play,” he says.
COPD symptoms such as dyspnea (breathlessness), cough, and mucus production can be evaluated by your doctor through different scales and questionnaires.
Exacerbation Risk
The third factor that doctors consider when classifying a patient under the GOLD Criteria is how frequently they experience an acute exacerbation, or flare-up, of symptoms. COPD exacerbations can be mild, moderate, or severe.
Often an exacerbation can be treated at home with medications such as an inhaler, corticosteroids, or antibiotics, but severe exacerbations require hospitalization or a visit to the emergency room. Early treatment for a severe exacerbation is important because in some cases they can be very serious and life-threatening, notes the American Thoracic Society.
What Are the 4 Stages of COPD?
T here are four stages of COPD, ranging from mild to very severe.
You may have also heard of a fifth stage, or “stage 0,” which is considered pre-COPD. This is a relatively new term used to describe patients of any age who present symptoms of COPD but still have normal FEV1 scores, according to the 2024 GOLD Report. These patients may still develop COPD over time.
GOLD Stage 1: Mild COPD
At this stage, your lung function measures at least 80 percent of predicted FEV1 value, and symptoms may be easy to dismiss.
The lowest severity level of COPD is characterized by:
Dyspnea (breathlessness)
Coughing
Sputum (phlegm)
“During mild stage COPD, you may feel out of breath during light physical activity, like doing housework or walking up the stairs,” says Umur Hatipoglu, MD, a pulmonologist at the Cleveland Clinic in Ohio. “A hacking cough that produces mucus is also common,” he adds.
The most important therapeutic option for those with mild COPD remains smoking cessation in those still smoking, says Byron Thomashow, MD, a professor of medicine at Columbia University in New York City and a cofounder of the COPD Foundation. A smoking cessation program can help you quit cigarette smoking and provide support along the way.
“Diagnosing the disease early could help push smokers to stop and potentially dramatically improve their future,” Dr. Thomashow says. “Having more mild disease does not necessarily mean there are no symptoms, but with available medications and rehab programs, we can often significantly improve these symptoms.”
While smoking is the most common cause of COPD, long-term exposure to lung irritants — including secondhand smoke, air pollution, and industrial dust and fumes — can also be a factor.
People with mild COPD who have symptoms may be prescribed a short-acting inhaler known as a bronchodilator to use as needed. These medications are delivered through an aerosol you inhale. It works by relaxing your airways, allowing you to breathe easier.
It’s recommended that people with COPD get yearly flu shots and stay up-to-date on vaccines to protect against pneumonia in order to prevent complications, according to the Centers for Disease Control and Prevention (CDC).
Catching and treating COPD early can help slow its progression, says Diaz. “If you’re not really experiencing symptoms, the most important reason to get diagnosed at an early stage is if you’re a smoker,” he says.
GOLD Stage 2: Moderate COPD
At this stage, your lung function measures 50 to 79 percent of predicted FEV1 value. With moderate COPD, shortness of breath during daily activities is more evident, and you may also experience increased coughing and mucus production, says Dr. Hatipoglu. “If you’re suffering from moderate stage COPD, you could be a good candidate for a pulmonary rehabilitation program,” he says.
Pulmonary rehab can help you exercise your lungs to improve lung health and increase your ability to be more active, according to the American Lung Association.
This program focuses on nutrition (to achieve a healthy weight), exercise, and other strategies that can help you control your symptoms and improve your quality of life. Although pulmonary rehab can be beneficial, it’s important to know that it will not cure your condition or reverse any lung damage caused by COPD, says Hatipoglu.
GOLD Stage 3: Severe COPD
At this stage, your lung function measures 30 to 49 percent of predicted FEV1 value, and you’ll likely experience symptoms beyond your respiratory system.
“Once you reach severe stage COPD, your quality of life is significantly impacted,” says Hatipoglu. Symptoms can include:
Shortness of breath that has become worse or occurs more often
More coughing or wheezing
Changes in thickness or amount of mucus
Extreme fatigue or weakness
Feelings of confusion or forgetfulness
“Inhaled medications that will open up the airways and help a person breathe easier are often used, and for patients who get frequent exacerbations, we often prescribe inhaled corticosteroids,” says Edelman.
When a person gets acute exacerbations, they are often prescribed antibiotics and several days of systemic steroids that come in the form of oral tablets, he adds.
GOLD Stage 4: Very Severe COPD
At this stage, your lung function measures less than 30 percent of predicted FEV1 value. This is considered end-stage COPD, and almost everything you do causes shortness of breath and limits your mobility, says Hatipoglu.
Breathing difficulties can even be life-threatening, and the lack of airflow coming into the lungs starts to affect the heart and circulatory system. “Oxygen therapy may be used in those with more severe disease,” says Thomashow. A portable oxygen tank can help improve your blood oxygen levels.
In people with severe COPD who have severe and frequent symptoms, lung volume reduction surgery and even a lung transplant can sometimes be an option. To be eligible for lung volume reduction surgery, a person must be strong enough to have the surgery, participate in a pulmonary rehab program, and not be a current smoker, according to the American Lung Association.
Complications of COPD can include respiratory infections that make it difficult to breathe and high blood pressure in the arteries of the lung (pulmonary hypertension). People with COPD also have a higher risk of developing heart problems and lung cancer.
The GOLD System and COPD Medications
Depending on the symptom burden and the number of exacerbations in the last year, a person diagnosed with COPD is also placed in a group of A, B, or E. This helps a doctor choose the best medication for initial treatment. This is different from the stages noted above; for example, a person with GOLD Stage 1 COPD may have symptoms and exacerbation, while a person with a more severe stage may not have symptoms or exacerbations.
Group A Both the severity of symptoms and the risk of exacerbations are low. The recommended treatment is a short- or long-acting bronchodilator.
Group B The severity of symptoms is high, but the risk of exacerbations is low. A combination of two different kinds of long-acting bronchodilators is recommended.
Group E The risk of exacerbations is high, regardless of the severity of symptoms. A combination long-acting bronchodilator is also the recommendation. But for people who have high levels of white blood cells called eosinophils, an inhaled corticosteroid may be added.
“People sometimes get the diagnosis of COPD and kind of freak out,” says Diaz. “They think it’s a death sentence, which is not the case. Not all of the COPD is the same; some can be very mild, and some can be more severe,” he says. “It’s possible to hold steady or to delay progression of COPD by making lifestyle changes,” Diaz says. “The most important thing to do is to stop smoking. If you’ve already stopped smoking, that can help slow the advancement of the disease.”
The Takeaway
The GOLD system is a way of assigning stages of COPD severity based on lung function, symptoms, and the frequency of flare-ups. Staging groups help doctors determine the most effective treatment, and help patients understand what to expect.
David Mannino, MD, is the chief medical officer at the COPD Foundation. He has a long history of research and engagement in respiratory health.
After completing medical training as a pulmonary care specialist, Dr. Mannino joined the Centers for Disease Control and Prevention (CDC) Air Pollution and Respiratory Health Branch. While at CDC, he helped to develop the National Asthma Program and led efforts on the Surveillance Reports that described the U.S. burden of asthma (1998) and COPD (2002).
After his retirement from CDC in 2004, Mannino joined the faculty at the University of Kentucky, where he was involved both clinically in the College of Medicine and as a teacher, researcher, and administrator in the College of Public Health. He served as professor and chair in the department of preventive medicine and environmental health from 2012 to 2017, with a joint appointment in the department of epidemiology.
In 2004, Mannino helped to launch the COPD Foundation, where he served as a board member from 2004 through 2015, chairman of the Medical and Scientific Advisory Committee from 2010 through 2015, and chief scientific officer from 2015 to 2017.
Mannino has over 350 publications and serves as an associate editor or editorial board member for the following journals: American Journal of Respiratory and Critical Care Medicine, Chest, Thorax, European Respiratory Journal, and the Journal of the COPD Foundation. He was also a coauthor of the Surgeon General’s Report on Tobacco in 2008 and 2014.
Becky Upham has worked throughout the health and wellness world for over 25 years. She's been a race director, a team recruiter for the Leukemia and Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.
Upham majored in English at the University of North Carolina and has a master's in English writing from Hollins University.
Upham enjoys teaching cycling classes, running, reading fiction, and making playlists.
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