Respiratory Definition of COPD Severity

Lothian Locality COPD Guidance: Principles for treatment at each stage of the disease

From the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2008. Available from: http://www.goldcopd.or

As well as spirometry, it is important to assess the patient’s symptoms using the MRC breathlessness scale:

I: Mild	II: Moderate	III: Severe	IV: Very severe
FEV1 ≥ 80% predicted FEV1/VC < 70% with or without symptoms	FEV1 < 80% predicted FEV1/VC < 70% with or without symptoms	FEV1 < 50% predicted FEV1/VC < 70% with or without symptoms	FEV1 < 30% predicted FEV1/VC < 70% presence of chronic respiratory failure or right heart failure

Avoidance of risk factor(s); influenza/pneumococcal vaccination – stop smoking – offer help at every opportunity

• ADD short-acting bronchodilator and/or anticholinergic when needed to help reduce breathlessness and increase exercise tolerance.
• ADD regular treatment with one or more long-acting bronchodilators.
• ADD pulmonary rehabilitation.
• ADD inhaled glucocorticosteroids if repeated exacerbations. If still symptomatic, CONSIDER adding theophylline.
• ADD long term oxygen therapy.
• If chronic respiratory failure, refer to secondary care.

• CONSIDER surgical treatments.