诊断标准

Global Initiative for Chronic Obstructive Lung Disease criteria[1]

Classification of severity of airflow limitation in COPD:

In pulmonary function testing, a postbronchodilator forced expiratory volume in the first second of expiration (FEV₁)/forced vital capacity (FVC) ratio of <0.7 is commonly considered diagnostic for COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) system categorizes airflow limitation into stages. In patients with FEV₁/FVC <0.7:

  • GOLD 1 - mild: FEV₁ ≥80% predicted

  • GOLD 2 - moderate: 50% ≤ FEV₁ <80% predicted

  • GOLD 3 - severe: 30% ≤ FEV₁ <50% predicted

  • GOLD 4 - very severe: FEV₁ <30% predicted

The GOLD guideline uses a combined "ABE" approach to assess patients according to their level of symptoms and previous history of exacerbations. Symptoms are assessed using the Modified British Medical Research Council (mMRC) or COPD assessment test (CAT) scale. These can be found in the GOLD guidelines. GOLD cautions against the use of the mMRC dyspnea scale alone for assessing patients, as symptoms of COPD go beyond dyspnea alone. For this reason, the CAT is preferred. However, GOLD acknowledges that the use of the mMRC scale is widespread, and so a threshold of an mMRC grade ≥2 is still included to define "more breathless" patients, as opposed to "less breathless" patients, in its assessment criteria. Exacerbations are assessed independently of symptoms to highlight their clinical relevance.

  • Group A: low risk (zero [0] moderate or severe exacerbations in the previous year) and fewer symptoms (mMRC 0-1 or CAT <10)

  • Group B: low risk (zero [0] moderate or severe exacerbations in the previous year) and more symptoms (mMRC ≥2 or CAT ≥10)

  • Group E: high risk (≥1 moderate or severe exacerbations in the previous year) and any level of symptoms

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