COPD is a progressive illness, meaning it gets worse over time. It may be harder to breathe, and you could have more symptoms, including flare-ups. What does COPD progression look like?
Signs COPD Is Getting Worse
Here are some symptoms you could have as your COPD gets worse:
- Coughing more than usual
- Changes to the color, thickness, or amount of your phlegm
- Trouble sleeping
- Shortness of breath that’s worse than usual
- Wheezing
- Loud breathing
- Extreme tiredness
- Weight loss
- A buildup of fluid in your ankles that causes swelling (edema)
- Chest pain
- Coughing up blood
COPD Symptoms at Each Stage
COPD has four stages ranging from mild to very severe, and each stage comes with distinct symptoms:
- Stage 1: Mild COPD. At this stage, you probably won’t have any COPD symptoms until you reach your 50s. If you do have symptoms, you may notice a dry, lingering cough that makes a small amount of phlegm. You could also be out of breath after exercise but may not recognize it as a COPD symptom.
- Stage 2: Moderate COPD. You have a lingering cough with phlegm, especially in the morning. You may also be out of breath, tired, have trouble sleeping, or wheeze. Some people with moderate COPD have flare-ups (exacerbations) that make their symptoms worse and change the color of their phlegm. COPD could also take a toll on your mental health.
- Stage 3: Severe COPD. With severe COPD, your symptoms worsen, and you have more flare-ups. This stage may also include chest infections, tightness, wheezing, and swelling in your ankles, feet, and legs.
- Stage 4: Very severe or end-stage COPD. You’ll have similar symptoms as stage 3, but worse. Even breathing is hard, and you may have serious flare-ups more often. Other symptoms include a crackling sound when you breathe in, barrel chest, severe confusion, changes to your heartbeat, weight loss, and high blood pressure in the arteries of your lungs (pulmonary hypertension).
The symptoms of COPD can look different from one person to the next and may not always follow these exact stages.
The GOLD Assessment
Another measure of whether your COPD has progressed is the GOLD test. GOLD stands for Global Initiative for Chronic Obstructive Lung Disease, which is a group that publishes guidelines for COPD care. Your doctor likely uses the GOLD assessment to create your COPD treatment plan. The test takes a few things into account when judging the severity of your COPD:
- Your spirometry results. During this test, you’ll blow into a large tube that’s connected to a machine called a spirometer. The results show how strong your lungs are by measuring the amount of air you can blow out. Doctors use spirometry to confirm a COPD diagnosis.
- Your symptoms. Your doctor will look at your COPD symptoms, like shortness of breath, wheezing, and a tight chest, and how they impact your life. Do you have a lack of energy or other health issues such as heart problems, respiratory infections, or depression?
- Your chances of a flare-up. This is when your symptoms abruptly get worse. A flare-up can linger for several days or longer.
Your doctor will then use this information to classify your COPD with a number ranging from grade 1 to grade 4 and a letter from group A to group D.
GOLD COPD Grades
Doctors base your COPD grade on the results of your spirometry, which measures how much of your airflow is blocked. The test reveals:
- Forced vital capacity(FVC), or how much air you can exhale at one time
- Forced expiratory volume in 1 second(FEV1), or how much air you can exhale by breathing out as hard as you can in 1 second
You have COPD if your FEV1/FVC is 70% or less. Based on your spirometry score and age, the illness can range from mild to very severe. Here’s a look at the different grades and levels of severity:
- Grade 1: Mild COPD (FEV1 80% or higher)
- Grade 2: Moderate COPD (FEV1 between 50% and 79%)
- Grade 3: Severe COPD (FEV1 between 30% and 49%)
- Grade 4: Very severe COPD (FEV1 less than 30%)
GOLD COPD Groups
The GOLD assessment also includes groups, ranging from letters A through D. Doctors will place you in one of these groups based on your symptoms, their severity, and your chances of having a flare-up.
You’re more likely to have a future COPD flare-up if you’ve had one recently. Your odds are:
- Low if you’ve gone without a COPD flare-up for 1 year or had one but didn’t need to go to the hospital
- High if you’ve had to go to the hospital for COPD within the past year or had two or more flare-ups within a year.
To rate your COPD symptoms, your doctor will ask you questions about your symptoms and their impact on your life. They typically use two questionnaires:
- COPD Assessment Test (CAT). Using a score of 0 to 40, you’ll consider how COPD symptoms, like cough, phlegm, mood, and sleep, affect your day-to-day life. The lower your score, the less impact your symptoms have.
- Modified MRC Dyspnea Scale (mMRC). This test measures breathlessness with a score from 0 to 4. A lower number equals fewer symptoms.
After gathering all this information, your doctor will give you a grade from A to D. Here’s what the grades mean:
- Group A: Low flare-up risk, less symptoms
- Group B: Low flare-up risk, more symptoms
- Group C: High flare-up risk, less symptoms
- Group D: High flare-up risk, more symptoms
Your grade and letter both give your doctor critical details on how to watch for changes to your COPD.
Show Sources
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SOURCES:
NHS: “Chronic obstructive pulmonary disease (COPD).”
American Lung Association: “Prevent COPD Exacerbations or Flare Ups.”
Global Allergy & Airways Patient Platform: “Four stages of COPD.”
Mayo Clinic: “COPD.”
