Chronic obstructive pulmonary disease (COPD) is an umbrella term that includes a variety of progressively debilitating lung diseases. COPD includes both emphysema and chronic bronchitis.

Cigarette smoking causes most COPD around the world. Despite worldwide efforts by health professionals to raise awareness about the dangers of smoking, COPD remains widespread.

The World Health Organization (WHO) estimates that COPD will rank as the world’s third leading cause of death by 2030. In 2014, COPD was already the third leading cause of death in the United States.

The National Institutes of Health (NIH) expects the situation to become worse. COPD currently affects as many as 24 million American men and women. However, only half of them are aware they have the disease.

In 1998, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) formed in order to promote COPD education and help set universal standards of treatment.

GOLD tries to stem the tide of COPD cases and promote increased public understanding. By 2001, GOLD filed its first report. Frequent revisions keep GOLD standards up to date.

The 2012 report advocated an individualized approach to COPD classification and treatment. The most recent update of the 2012 report was published in January 2018.

The 2018 GOLD report includes updates rooted in evidence-based medicine. Recommendations integrate important study findings. The report doesn’t just ask whether a treatment improves lung function. It also questions whether an intervention improves patient outcomes or quality of life.

The GOLD committee explained that people with COPD shouldn’t be evaluated only by lung function tests. Consideration of a variety of factors, such as day-to-day symptoms, leads to a more accurate COPD diagnosis.

The 2018 revision includes the latest standards for medication use. These affect widely used treatments, such as corticosteroids (CSs), long-acting bronchodilators (BDs), and anticholinergics (ACs).

The latest study results are reflected in recommended dosages and drug delivery methods.

The 2018 revision recommends assessment of a person’s symptoms and history of exacerbations along with lung function tests.

In the past, the four stages of COPD were based only on the result of forced expiratory volume (FEV1) numbers on lung function tests. The GOLD committee has determined that this has greatly underestimated the severity of disease.

Therefore, the new guidelines classify COPD in four new stages taking a person’s symptoms under consideration.

The COPD Assessment Test(CAT) or modified Medical Research Council (mMRC) dyspnea scale ask people a series of questions to assess their breathing during daily activities. The answers are given point values for a numerical score.

The GOLD committee recommends either of these tools in the classification of the four stages of COPD according to its severity.

Group A individuals have a low risk of future exacerbations.

This is indicated by lung function tests resulting in FEV1 numbers at less than 80 percent of normal (a stage formerly known as GOLD 1) or FEV1 numbers between 50 and 79 percent of normal (formerly GOLD 2).

Group A individuals also have zero to one exacerbations per year and have no prior history of hospitalizations for COPD exacerbation. They also have a CAT score of less than 10 or an mMRC score of 0 to 1.

Group B individuals have the same lung function tests as those in Group A. They also only have zero to one exacerbations per year with no prior history of hospitalization for exacerbations.

However, they have more symptoms and therefore have a CAT score of 10 or more, or an mMRC score of 2 or more.

Group C individuals are at high risk for future exacerbations. Lung function tests show between 30 and 49 percent of normal (formerly GOLD 3) or less than 30 percent of normal (formerly GOLD 4).

They experience two or more exacerbations per year and have been hospitalized at least once for a respiratory problem. They have fewer symptoms, so they have a CAT score of less than 10 or an mMRC score of 0 to 1.

Group D individuals are also at high risk for future exacerbations. They have similar lung function test results as people in Group C, have two or more exacerbations per year, and have been hospitalized at least once for an exacerbation.

They experience more symptoms, so they have a CAT score of 10 or greater, or an mMRC score of 2 or more.

The GOLD guidelines reflect universal standards in diagnosis and treatment. The ultimate GOLD mission is to increase awareness of COPD. Proper diagnosis and treatment increases the lifespan and quality of life in people with COPD.

COPD is a complex disease. Many other health conditions can also affect lung function. Talk with your doctor about treatments and lifestyle changes if you have any of these issues: