GOLD guidelines established a classification of COPD severity into four main
stages, as reported in the following table
(Table 6).
Table 6: GOLD, 2010 Update
This classification has been drawn on the basis of airflow limitation
measurements (FEV1% predicted values), together with the severity of
symptoms and potential complications of the disease (pulmonary failure and
related cor pulmonale-right heart failure). Although the classification mainly
relies on the airflow limitation degree, COPD management is normally
designed on the impact that symptoms have on patients quality of life.
Interestingly, there is no direct relationship between the degree of airflow
limitation and the intensity of symptoms: thus, the described classification
should be considered as an important tool, but it should always be supported
by a specific evaluation of all the factors suggested in Table 7. This meticulous
method leads to an individualized assessment of COPD severity level, allowing
physicians to plan a proper pharmacological treatment.
As aforementioned, symptoms
manifestation is not directly
related to airflow limitation and
chronic cough and sputum
production often precede airflow
limitation development, which
sometimes not even occurs.
Therefore, symptoms monitoring
offers the opportunity of an
early intervention in those
patients where the disease is
not yet a serious problem.
Table 7: GOLD, 2010 Update
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