COPD Awareness: Understanding the Diagnosis and Stages

BelluscuraKnowledge

COPD Day

November 18, 2020 – World COPD Day

Awareness

Being told you have chronic obstructive pulmonary disease (COPD) can be overwhelming. COPD is a progressive disease that obstructs the airflow, making it difficult to breathe and get enough oxygen into your lungs. According to the Chest Foundation, COPD is the third leading cause of death in the US and impacts roughly 24 million Americans.

COPD is made up of two diseases; emphysema accounts for 33 percent, and chronic bronchitis accounts for the remaining 64 percent of diagnosed cases. Emphysema occurs due to the damage that happens to the air sacs in the lungs. These air sacs overfill with air and lose their elasticity which makes it hard to exhale the excess air. In chronic bronchitis, the airways become swollen and inflamed and produce large amounts of mucus. The increased production of mucus obstructs the airways, narrows them, and makes it hard to breathe.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has classified four stages in which your healthcare provider will determine what stage of COPD you are in. This will help them determine the best treatment plan for you.

Symptoms

The first part of diagnosing your condition will consist of assessing symptoms. It will be important to provide your healthcare provider with the symptoms you have been having that have led you to seek medical attention. Common COPD symptoms include:

  • Shortness of breath
  • Chronic cough
  • New or increased wheezing
  • Coughing up phlegm or and increase in phlegm

Risk Factors

It will be important for your healthcare provider to know if you have had or are currently exposed to any risk factors. Risk factors could include things such as:

  • Genetic factors
  • Abnormalities from birth
  • Tobacco smoke
  • Smoke from cooking/heating fuels
  • Dust
  • Vapor
  • Fumes or other inhaled chemicals

Spirometry

Spirometry will play a large role in your COPD diagnosis. Once you have sought medical care for COPD related symptoms and you have discussed your risk factors, the next step will be for your healthcare provider to order spirometry.

Spirometry is a common breathing test used to see how well your lungs are working by taking a few test measurements while you breathe into a machine. Spirometry will measure the air you breathe in, the air you breathe out, and how quickly you breathe out.

One of the initial spirometry tests that will be performed is called the Forced Vital Capacity (FVC) measurement or the amount of forced air that you can exhale and inhale into the machine. An equally important measurement is the calculation based on the Forced Expiratory Volume in One Second (FEV1). This is the amount of air you can breathe out of the lungs in the first one second of forced expiration.

Your FEV1 is based on factors including your age, sex, height, and ethnicity.  Your healthcare provider will compare your results to a healthy individual and any deviations in measurements are what will lead to a sign of what might be causing your problems.

You will be given a breathing treatment with medication to help open your lungs such as a bronchodilator before you start the test. This is to ensure your lungs are performing at their best.

After your test is completed, your healthcare provider will review the measurements and see which of the four GOLD stages of COPD you fall into based on your results. This testing will serve as a follow-up assessment to determine what other therapies can work for you and to monitor you as the disease progresses.

Four Stages of GOLD

Your spirometry results, particularly your FEV1, will fall into one of the four GOLD classifications of severity which is how your COPD stage will be determined.

COPD Fast Facts

GOLD 1
  • Mild Stage, Stage I COPD
  • FEV1  greater than/or equal to 80% of predicted test results compared to a healthy individual
  • In this stage, you will likely experience very mild symptoms
GOLD 2
  • Moderate Stage, Stage II COPD
  • FEV1 between 50 – 79% of predicted test results compared to a healthy individual
  • Symptoms include shortness of breath with activity, cough, and sputum production
GOLD 3
  • Severe Stage, Stage III COPD
  • FEV1  between 30 – 49% of predicted test results compared to a healthy individual
  • In this stage, you may experience shortness of breath, fatigue, and a lower tolerance to physical as well as more frequent COPD exacerbations
GOLD 4
  • Very Severe, Stage III COPD sometimes referred to as End-Stage COPD
  • FEV1 less than 30 % of predicted test results compared to a healthy individual
  • In this stage, you may find that your quality of life is significantly decreased, and you may experience severe and life-threatening exacerbations

Takeaway

COPD is a chronic disease that cannot be cured and as time goes on, the disease progresses. Certain treatments and lifestyle changes can help you manage your symptoms and improve your quality of life. It is important to seek out a healthcare provider who will work with you to improve your breathing.

Sources:

https://foundation.chestnet.org/lung-health-a-z/chronic-obstructive-pulmonary-disease-copd/

https://www.who.int/respiratory/copd/burden/en/

https://goldcopd.org/