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C: Confirm diagnosis C3. Assessing the severity of COPD
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C3. Assessing the severity of COPD
Spirometry is the most reproducible, standardised and objective way of measuring airflow limitation, and FEV1 is the variable most closely associated with prognosis. (Peto et al., 1983) The grades of severity according to FEV1 and the likely symptoms and complications are shown in Box 6. However, it should be noted that patients with an FEV1 >80% predicted, although within the normal range, may have airflow limitation (FEV1/FVC ratio <70%).
A recent Spanish cohort study of 611 COPD patients found that the British Thoracic Society classification (which is very similar to Box 6) had the optimal sensitivity and specificity against the criterion of all cause and respiratory mortality over 5 years.(Esteban et al., 2009) There were also significant differences in health related quality of life between different stages of the disease [evidence level III-2].
Box 6: Classification of severity of chronic obstructive pulmonary disease (COPD) (NHLBI/WHO Workshop Report, April 2001) |
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COPD severity |
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Factor |
Mild |
Moderate |
Severe |
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Spirometry findings postbronchodilator FEV1 |
60-80% predicted |
40-59% predicted |
<40% predicted |
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Functional assessment (activities of daily living) |
Few symptoms No effect on daily activities Breathless on moderate exertion |
Increasing dyspnoea Breathless on the flat Increasing limitation of daily activities |
Dyspnoea on minimal exertion Daily activities severely curtailed |
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Complications |
No |
Exclude complications; consider sleep apnoea if there is pulmonary hypertension |
Severe hypoxaemia (Pao2 45mmHg, or 6kPa) Pulmonary hypertension Heart failure Polycythaemia |
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FEV1=forced expiratory volume in one second. Pao2=partial pressure of oxygen, arterial. Paco2=partial pressure of carbon dioxide, arterial. |
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COPD-X Plan - Version 2.30 - December 2011
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