What Are the COPD Gold Stages

Quincy AdamCOPD Lifestyle

Doctor with patient

If you or a loved one has chronic obstructive pulmonary disease (COPD), you’ve likely heard of the Gold Stages but may need a little help understanding what they mean and how medical professionals use them.

The Global Initiative for Chronic Obstructive Lung Disease, established in 1998, has published its COPD GOLD guidelines since 2001.1 Initially, the objective of the GOLD stages was to diagnose and improve the management and prevention of COPD.

The COPD GOLD assessment was initially based exclusively on the results of a pulmonary function test called spirometry. Healthcare professionals express pulmonary function test results as percentages of the breath exhaled or, in more technical terms, the forced vital capacity (FVC), of people with normal lung function. Also, they measure the forced expiratory volume in one second (FEV1) as a percentage of FVC. Pulmonary function test results are used to assign patients to one of four stages:

  • GOLD 1: Mild—FEV1 – 80% or more of FVC of people with normal lung function.
  • GOLD 2: Moderate—FEV1 ranges from 50% to 80% of FVC in normal lung function.
  • GOLD 3: Severe—FEV1 ranges from 30% to 50% of FVC in normal lung function.
  • GOLD 4: Very Severe—FEV1 is less than 30% of FVC in normal lung function.

Post 2011 COPD GOLD Grading—Combined Assessment

Now, it gets a little more complicated. Since 2011, the COPD GOLD guidelines have included additional assessment tools.2 They’ve combined the results to grade COPD patients from A through D. The purpose is to go beyond diagnosing the stage of COPD to assisting doctors in prescribing treatments and medications.

Today, COPD is assessed based on:

  • Pulmonary function
  • COPD symptoms
  • History of COPD exacerbations

Either the modified Medical Research Council questionnaire or the newer COPD Assessment Test (CAT) survey would be used to assess your symptoms. Your risk of exacerbations is based on your history of exacerbations and the pulmonary function test. For example, a high risk for exacerbations will be assessed if you have two or more flare-ups within a year, or FEV1 below 50 percent or one or more hospitalizations for COPD.

When factors for symptoms, airflow obstruction, and history of exacerbations are combined the grades look like this:3

GOLD A

  • Symptoms: Low risk/less symptoms
  • Spirometric Classification: GOLD 1-2
  • Exacerbations per Year: Not more than 1
  • CAT: Less than 10
  • Medical Research Council questionnaire: 0-1

GOLD B

  • Characteristic: Low risk/more symptoms
  • Spirometric Classification: GOLD 1-2
  • Exacerbations per Year: Not more than 1
  • CAT score: 10 or higher
  • Medical Research Council questionnaire: 2 or higher

GOLD C

  • Characteristic: High risk/less Symptoms
  • Spirometric Classification: GOLD 3-4
  • Exacerbations per Year: 2 or more
  • CAT score: Less than 10
  • Medical Research Council questionnaire: 0-1

GOLD D

  • Characteristic: High risk/more symptoms
  • Spirometric Classification: GOLD 3-4
  • Exacerbations per Year: 2 or more
  • CAT score: 10 or higher
  • Medical Research Council questionnaire: 2 or higher

Benefits from New COPD GOLD Grades

Yes, there are several layers of complexity to the new COPD GOLD grades. However, the objectives are worthwhile: to help healthcare professionals and patients go beyond diagnosing COPD according to airway obstruction. Increasingly, COPD GOLD grades can be used in clinical practices to prescribe treatment options, including medications, in order to manage and maintain a stable COPD condition and prevent and manage COPD exacerbations.

For the latest in COPD GOLD guidelines, visit the Global Initiative for Chronic Obstructive Lung Disease website. You will find up-to-date documents and resources that you can download.


1 Jørgen Vestbo, Suzanne S. Hurd, Alvar G. Agustı´, Paul W. Jones, Claus Vogelmeier,Antonio Anzueto, Peter J. Barnes, Leonardo M. Fabbri, Fernando J. Martinez,Masaharu Nishimura, Robert A. Stockley, Don D. Sin, Roberto Rodriguez-Roisin. Pulmonary Perspective. American Journal of Respiratory and Critical Care Medicine. 2013; Volume 187. http://www.atsjournals.org/doi/pdf/10.1164/rccm.201204-0596PP.2 Brett Ley, MD. The 2011 GOLD classification for COPD: Old GOLD vs. New GOLD Guidelines. PulmCCM website. http://pulmccm.org/main/2013/review-articles/new-gold-guidelines-2013-better-than-the-old-gold/. April 5, 2013.

3 Brett Ley. “New GOLD Guidelines: Better Than the Old GOLD,” PulmCCM website, http://pulmccm.org/main/2013/review-articles/new-gold-guidelines-2013-better-than-the-old-gold/ April 5, 2013.