Introduction
COPD is a chronic obstructive pulmonary disease. Depending on the severity of the disease, different stages of COPD can be distinguished. Classification into stages gives doctors information about the patient’s health and symptoms and the progress of the disease.
This helps them to make a decision about what treatment measures are necessary. One of the classifications is based on the results of lung function diagnostics (spirometry). Another classification into stages is based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD). In addition to certain lung function parameters (FEV1 and Tiffneau index), this takes into account the severity of symptoms. The severity of the symptoms is measured using special standardised questionnaires and the number of acute exacerbations of COPD.
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There is a classification based on testing lung function alone. This is used to classify lung function into four degrees of severity (I, II, III, IV). The patient’s symptoms are not decisive for this classification.
The interpretation of measured data of the lung function for stage classification is only possible if there is no acute worsening of COPD (exacerbation) at the time of measurement. A further classification according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) takes into account not only the results of spirometry but also the severity of the patient’s symptoms using standardized questionnaires. This classification is also based on four stages (GOLD A, GOLD B, GOLD C and GOLD D).
Stage 1 COPD is defined as COPD in stage 1 when the spirometry of the lung (pulmonary function diagnostics) shows a one-second capacity (FEV1, Forced Expiratory Volume per second) of more than 80 percent of the normal value. This is the respiratory volume that can be exhaled with full force within the first second after maximum inhalation. This value allows conclusions to be drawn about a possible narrowing (obstruction) of the airways.
The Tiffneau index is also of interest when evaluating spirometry in COPD patients. This is also known as the relative one-second capacity and results from the ratio of FEV1 to another specific lung volume (vital capacity, lung volume between maximum inhalation and maximum inspiration). Typical symptoms of COPD are chronic coughing, sputum due to increased mucus production and shortness of breath.
In this “mild” stage of COPD, however, it is still possible that neither chronic coughing nor increased mucus production is present. A shortness of breath, the so-called dyspnoea, is often not yet consciously perceived by the patient in this stage. In the early stages, the disease is often confused with “smoker’s cough” or a mild respiratory infection.
As there are usually no impairments in everyday life, the affected patients are often not yet aware that they suffer from a chronic obstructive pulmonary disease. Stage 2 is a moderate or moderate form of COPD. In this stage, breathlessness, a so-called dyspnoea, only occurs under stress.
It is therefore also possible that patients who are not very active in sports and generally have a relatively sedentary lifestyle will not notice any deterioration in their state of health. The one-second capacity (FEV1) measured in spirometry is 50-80 percent of the normal value in the second stage. Symptoms of COPD such as chronic coughing and sputum are more pronounced, but may be absent in some cases.
Typical is the morning coughing up of sputum. This is a coughing up and mucous secretion. However, the absence of sputum or only small amounts of sputum do not rule out COPD.
When the third stage of COPD is reached, it is already a severe form. In this case, a large number of the alveoli, also known as alveoli, have already lost their functionality. The one-second capacity measured in spirometry is only 30 to 50 percent of normal in stage three.
The one-second capacity (FEV1) is a breathing volume that can be exhaled within the first second after maximum inhalation. The one-second capacity allows conclusions to be drawn about a possible narrowing (obstruction) of the airways. The leading symptoms of COPD, chronic coughing and sputum, are more noticeable in the third stage of the disease.
Even minor physical exertion, such as climbing stairs or walking for long periods, can cause severe respiratory distress in affected individuals. Many patients also have problems coughing up secretions (sputum) in the morning. At this stage, patients may also already have cardiovascular problems.
These can arise as a result of chronic oxygen deficiency. If symptoms occur, a doctor should always be contacted and the symptoms clarified by a doctor. Even at this stage, there are still few patients who suffer little or no from the above-mentioned symptoms.
Therefore, even at this stage, it is possible that those affected are not yet aware of the presence of a chronic obstructive pulmonary disease. If the one-second capacity measured by spirometry is less than 30 percent of the normal value, the disease is already very advanced and COPD is in stage four, which is also the final stage. At this time, the patients are chronically undersupplied with oxygen.
They suffer from severe breathing difficulties even when at rest, which is why their physical fitness is very limited. In addition, the patients suffer from a very pronounced chronic cough with sputum. Since COPD is a systemic disease that affects the entire organism, it can cause many other diseases.
Especially patients with high stages of COPD, who already have a long course of the disease, often have another disease that requires treatment. In older patients, there are often even several. This is due to the fact that COPD is associated with a high level of physical stress, which weakens the entire organism.
As a result, secondary diseases such as cardiovascular weakness, right heart weakness (cor pulmonale), diabetes or osteoporosis are more likely. In addition, in the advanced stages of the disease, there may be severe weight loss, which in turn leads to loss of muscle mass and bone density and an increase in insulin resistance, which then causes blood sugar to rise. To break this vicious circle, it is important to counteract the weight loss with appropriate nutrition.
In addition, so-called exacerbations pose a life-threatening threat to the patient in late stages. Exacerbations are the acute attacks of chronic obstructive pulmonary disease. If respiratory insufficiency is already present, the patient is given oxygen via nasal cannula as part of an oxygen therapy (LOT).
This enables patients to expand their range of movement (play). In addition to an improvement in the quality of life, oxygen therapy leads to an increase in life expectancy. In the case of very severe forms of COPD, surgical intervention, such as a lung transplant or lung volume reduction, can also be considered for certain patient groups at this stage. This is an attempt to counteract the constant over-inflation of the lungs.
