Early COPD is present when:
- Age <50 years
- EV1/FVC < 0.70, FEV1 > 50% of target value
Assess severity of COPD by lung function impairment (GOLD criteria; Global Initiative for Chronic Obstructive Lung Disease):
Patients with FEV1/FVC<0.70 (based on FEF1 after administration of a bronchodilator/”asthma spray”). | ||
Severity | Risk group | FEV1 |
Severity I (GOLD 1) | Mild | FEV1 ≥ 0.80% of the target value |
Severity II (GOLD 2) | Moderate | 50 % ≤ FEV1 < 80 % of the target value |
Severity III (GOLD 3) | Severe | 30 % ≤ FEV1< 50 % of the target value |
Severity IV (GOLD 4) | very severe | FEV1 <30% of the set point |
Legend
- FEV1 = forced expiratory one-second volume.
- FVC=forced expiratory vital capacity (= lung volume that can be exhaled at maximum rate (forced) after maximum inspiration (inhalation)).
For everyday practice, the BODE index has become widely accepted:
Parameter | 0 points | 1 point | 2 points | 3 points |
FEV 1 (%) | ≥ 65 | 64-50 | 49-36 | ≤ 35 |
Walking distance in 6 min (in m) | ≥ 350 | 349-250 | 249-150 | ≤ 149 |
mMRC Dyspnea Scale | 0-1 | 2 | 3 | 4 |
Body mass index (BMI; kg/m²) | > 21 | ≤ 21 |
Legend
- FEV1 = forced expiratory one-second volume.
- MMRC Dyspnea Scale =scale used to classify dyspnea (see below).
The BODE index is used for prognosis and follow-up of COPD.
Evaluation:
- Correlation with all-cause mortality: the higher the score, the higher the mortality (mortality).
In the revised guidelines, exacerbation history plays a greater role, along with GOLD classification and symptomatology:
Risk | Classificationby GOLD | Number of exacerbations in the last 12 months | ||
High risk | C | D | 43 |
|
Low risk | A | B | 21 |
|
less symptoms | more symptoms | |||
mMRC 0-1CAT < 10 | mMRC ≥ 2CAT ≥ 10 |
CAT = COPD Assessment Test
mMRC = (Modified British Medical Research Council): classification of dyspnea (shortness of breath) in COPD patients according to mMRC:
mMRC grade | Description |
0 | Dyspnea (shortness of breath) during heavy exertion |
I | Dyspnea during rapid walking or during gentle ascents |
II | Walking slower than peers due to dyspnea |
III | Dyspnea at walking distance around 100 m |
IV | Dyspnea during dressing/dressing |
The higher the grade, the more severe the dyspnea.