GOLD Spirometric Criteria for COPD Severity
GOLD Spirometric Criteria for COPD Severity
I. Mild COPD * FEV1/FVC < 0.7 At this stage, the patient is probably unaware
that lung function is starting to decline
* FEV1 >/= 80% predicted
II. Moderate * FEV1/FVC < 0.7 Symptoms during this stage progress, with
COPD shortness of breath developing upon exertion.
* 50% </= FEV1 < 80% predicted
III. Severe * FEV1/FVC < 0.7 Shortness of breath becomes worse at this
COPD stage and COPD exacerbations are common.
* 30% </= FEV1 < 50% predicted
IV. Very Severe * FEV1/FVC < 0.7 Quality of life at this stage is gravely impaired.
COPD COPD exacerbations can be life threatening.
* FEV1 < 30% predicted or FEV1 < 50%
predicted with chronic respiratory failure
Examples:
Case # 1.
Predicted Values Measured Values % Predicted
FVC 6.00 liters 4.00 liters 67 %
FEV1 5.00 liters 2.00 liters 40 %
FEV1/FVC 83 % 50 % 60 %
Decision : This person is obstructed
Case # 2.
Predicted Values Measured Values % Predicted
FVC 5.68 liters 4.43 liters 78 %
FEV1 4.90 liters 3.52 liters 72 %
FEV1/FVC 84 % 79 % 94 %
Decision : This person is restricted
Case # 3.
Predicted Values Measured Values % Predicted
FVC 5.04 liters 5.98 liters 119 %
FEV1 4.11 liters 4.58 liters 111 %
FEV1/FVC 82 % 77 % 94 %
Decision : This person is normal. This person is normal because the FVC and
FEV1 are normal. It is irrelevant that the %Predicted for FEV1/FVC is 94%
when FVC & FEV1 are normal. The % predicted values for FEV1/FVC are only
relevant when the FVC and the FEV1 are abnormal.
Case # 4.
Predicted Values Measured Values % Predicted
FVC 3.20 liters 2.48 liters 77 %
FEV1 2.51 liters 2.19 liters 87 %
FEV1/FVC 78 % 88 % 115 %
Decision : Case 5.
Predicted Values Measured Values % Predicted
FVC 3.20 liters 3.01 liters 94 %
FEV1 2.51 liters 1.19 liters 47 %
FEV1/FVC 78 % 39 % 50 %
Decision : Case 6.
Predicted Values Measured Values % Predicted
FVC 4.80 liters 4.10 liters 85 %
FEV1 3.65 liters 3.10 liters 85 %
FEV1/FVC 76 % 76 % 100 %
Decision :
Normal spirometry
The Forced vital capacity (FVC) of the lung is the volume of air that can
be forcibly expelled from the lung from the maximum inspiration to the
maximum expiration.
Forced expiratory volume in 1 second (FEV1) is the volume of air that can
be expelled from maximum inspiration in the first second.
Restrictive pattern
Due to conditions in which the lung volume is reduced eg fibrosing
alveolitis, scoliosis. The FEV1 and FVC are reduced proportionately.
Obstructive pattern
Due to conditions in which the airways are obstructed eg asthma or COPD.
The FEV1 and FVC are reduced disproportionately.
Severity of COPD
National guidelines vary:
FEV1 as a % of predicted
<80% = mild <80% = mild
<60% = moderate <50% = moderate
<40% = severe <30% = severe
(NICE guidelines)
Forced expiratory ratio (FEV1/FVC ratio of FEV1%)
The FEV1/FVC ration is the FEV1 expressed as a percentage of the FVC (or
VC if that is greater) ie the proportion of the vital capacity inhaled in the
first second. It distinguishes between reduced FEV1 due to restricted lung
volume and that due to obstruction. Obstruction is defined as an
FEV1/FVC ratio of <70%
Restrictive ventilatory pattern Obstructive ventilatory pattern
FVC = 2.00 FVC = 3.50
litres (40% litres (98%
predicted) predicted)
FEV1 = 1.80 FEV1 = 1.80
litres (45% litres (58%
predicted) predicted)
FEV1/FVC FEV1/FVC
=90% =51%
FVC FVC normal
reduced or reduced
<80% FEV1
FEV1 reduced
reduced <80%
FEV1/FVC FEV1/FVC
ratio ratio
normal reduced
Flow volume loops
This is the same forced expiration converted electronically to illustrate
flow rate as the lung empties. The x axis represents volume - from full
inspiration to full expiration. The y axis represents the flow rate. The
shape of the flow volume loop depends on the mechanical properties of
the lung, and the shape can give important clues about diagnosis. The
dotted line is normal.
Asthma Typically the curve is a smooth concave shape as
the airway obstruction is relatively stable
throughout expiration.
COPD Typically the curve is angled as the damaged lungs
in COPD collapse with forced expiration.
Restrictiv Typically the curve is of normal height, but very
e steep as the lung volume is decreased.
