The Four Stages of Chronic Obstructive Pulmonary Disease (COPD)

Health Line

02-07-2025

Key takeaways
COPD is a progressive lung disease with mild symptoms in the early stages that gradually worsen. Early diagnosis and treatment can help preserve lung function.
The GOLD system previously classified COPD from stages 1 to 4 based on lung capacity as measured by a spirometry test. New guidelines now combine spirometry results with symptom severity to assess risk and determine staging.
Quitting smoking and avoiding secondhand smoke after receiving a diagnosis of COPD can improve your life expectancy and outlook.
People with COPD often have trouble breathing, a persistent cough, and shortness of breath. COPD can be subdivided into stages or grades, depending on how far it has progressed.
It is most common in smokers and people over the age of 40.
Keep reading to learn about the four stages of COPD. We'll discuss the symptoms you can expect at each stage and potential treatment options.
What is the GOLD system for categorizing COPD severity?
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is a program started by the National Heart, Lung, and Blood Institute (NHLBI) and the World Health Organization (WHO). Countries around the world use its guidelines and recommendations for diagnosing and treating COPD.
The GOLD system previously classified COPD from stages 1 to 4 solely based on your lung capacity measured by a spirometry test. But the newest GOLD guidelines combine your spirometry results with subjective measures of your symptom severity to determine your level of risk based on their ABCD rubric.
A spirometer test involves exhaling into a machine called a spirometer. The machine measures how hard and quickly you can exhale.
Your doctor examines two numbers in your results: your force vital capacity (FVC) and your force expiratory volume in one second (FEV1). Your FVC is the total amount of air you can breathe out and FEV1 is the amount you breathe out in one second. A ratio of your FEV1/FVC needs to be less than 0.7 for a diagnosis of COPD.
Doctors grade your spirometry results from grade 1 (least severe) to grade 4 (most severe). In the old system, these grades correlate with stage 1 to stage 4 COPD.
Doctors determine the severity of your symptoms using either the British Medical Research Council (mMRC) questionnaire or the COPD Assessment Test (CAT).
Stage 1: Early
Stage 1 COPD is considered mild. At this stage, you may not be aware that you have anything wrong with your lung function. A doctor assigns you with grade 1 COPD if your FEV1 is between 80 and 100% of your predicted value.
Symptoms
If you score grade 1 on your spirometry test, you may not have any noticeable symptoms. If you do have symptoms, you may develop a cough and increased mucus production. You may mistake the early stages of COPD for the flu.
Treatment
With stage 1 COPD, your doctor may recommend a bronchodilator medication to open up the airways in your lungs. These medications are usually taken through an inhaler or nebulizer.
Your doctor may also recommend getting flu, COVID-19, and pneumonia vaccines to prevent illnesses that may worsen your respiratory symptoms.
Changing lifestyle habits that led to the development of COPD can potentially help slow the progression of your COPD.
Most people with COPD have a history of smoking. Quitting smoking and avoiding secondhand smoke are two of the most important things you can do to improve your outlook with COPD.
Stage 2: Mild
Your COPD is considered to be stage 2 when your FEV1 drops to 50 to 79% of your predicted value.
Symptoms
During stage 2, your symptoms worsen from stage 1. Your coughing and mucus production may become more severe, and you may experience shortness of breath when walking or exercising. Typically, it's in this stage that people realize that something is wrong and seek medical attention from a doctor.
Treatment
You may be given bronchodilator medication to increase airflow to your lungs.
Your doctor may recommend pulmonary rehabilitation, a program designed to increase your awareness about your condition. It's usually offered as a group class where you learn how to manage your condition better.
If you have a flare-up of symptoms, you may need to take steroids or oxygen.
Stage 3: Severe
By the time you reach stage 3, COPD is considered severe, and your forced expiratory volume is between 30 to 50 percent of your predicted value. You may have trouble catching your breath doing household chores and may not be able to leave your house.
Symptoms
By stage 3, you may get more frequent flare-ups, and your shortness of breath and coughing typically get worse. You will likely find you get tired easier than before.
Other potential symptoms can include:
Treatment
The treatment options for stage 3 COPD are similar to stage 2. You're more likely to need oxygen therapy at this stage.
Stage 4: Very severe
Stage 4 is considered very severe. Your forced expiratory volume is less than 30% of your normal value, and your blood oxygen levels are also low. You're at risk of developing COPD complications like heart or lung failure.
Symptoms
By stage 4, you'll likely have frequent flare-ups that can be potentially fatal. You may have trouble breathing even when you're resting.
Treatment
Treatment options during stage 4 are similar to the previous stages. Your doctor may also recommend lung surgery to improve breathing. Surgical options include:
lung transplant
lung volume reduction surgery
bullectomy
Is there an end stage to COPD?
A grade 4 score on your spirometry test is the highest grade you can receive. This category is also sometimes referred to as end stage COPD.
For many people at this stage, quality of life is usually fairly low, and symptom flare-ups can be fatal.
What is the life expectancy of someone with COPD?
Having COPD lowers your life expectancy. However, the amount that it affects your life expectancy depends on many factors, such as how far your COPD has progressed and whether you quit smoking or change the other lifestyle habits that lead to COPD.
An older 2009 study found that COPD led to a small reduction in life span for people who have never smoked, but a larger life span decrease for people who currently smoke or smoked in the past.
According to the researchers, a 65-year-old man who smokes would lose 3.5 years from their life expectancy for smoking, plus the following values for having COPD:
Stage 1: 0.3 years
Stage 2: 2.2 years
Stage 3 or 4: 5.8 years
For former smokers, the reductions are:
Stage 1: 1.4 years
Stage 2, 3, or 4: 5.6 years
For somebody who never smoked, the reductions are:
Stage 2: 0.7 years
Stage 3 or 4: 1.3 years
In a 2017 study, researchers followed a group of long-term smokers with COPD for 5 years. They found that participants who had died before a 5-year follow-up had a longer average smoking time and a lower prevalence of quitting smoking. The researchers concluded that smoking time may be related to COPD mortality rate, and quitting smoking has the largest potential to influence COPD outlook.
A 2020 study of 532 people with COPD at a hospital in Taiwan suggests that loss of life years can vary based on a person's GOLD stage:
GOLD stage 1: no reduction
GOLD stage 2: 6.2 years
GOLD stage 3: 9.3 years
GOLD stage 4: 9.4 years
This study did not distinguish by smoking history.
Can you prevent COPD from progressing?
COPD can't be reversed, and it's currently not possible to stop the progression of your COPD completely. You can help slow the progression of COPD as much as possible by working with your doctor and following a proper treatment program.
Living with COPD
No matter how far your COPD has progressed, it's important to change the lifestyle habits that caused your COPD in the first place. The most important thing you can do is quit smoking. If you don't quit, you'll continue to damage your lungs, and your COPD will progress quicker than it would otherwise.
Eating a nutrient-rich eating plan filled with plenty of vegetables, healthy fats, protein, and unprocessed foods may help you manage your symptoms and maintain a healthy weight. Eating foods that cause bloating, like apricots or peaches, may worsen breathing problems in some people.
Regular exercise may help decrease symptoms of COPD by strengthening your respiratory muscles and improving your cardiovascular health. Your doctor may be able to suggest exercise that is safe for you.