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Emphysema Stages

Two sytems exist which describe the stages of emphysema, GOLD and BODE. While GOLD is the most common and widely known, the BODE system provides a more accurate determination of the actual stage a patient is in.

GOLD or the Global Initiative on Obstructive Lung Disease, uses the PFT results in determining the stage a patient is in while the more accurate, BODE system uses additional factors including body mass index, shortness of breath or "dyspnea" and exercise capacity along with the results of the pulmonary function test.

Most people diagnosed with emphysema are told by their doctors that the disease is "progressive" which you may have realized, is essentially the new name for terminal. The doctors then prescribe medications and treatments that are supposed to "slow the progress of the disease."

This has been determined by clinical trials performed by the very companies that developed the medications in the first place. I question the results of these clinical trials for this reason.

After my mother had been on these emphysema treatments and medications for approximately two years, her deterioration seemed like it was accelerating! This was my second reason for questioning the results of the clinical trials that claimed these emphysema medications and treatments were actually slowing the progress of the disease.

If you are like most people diagnosed with emphysema you take the medications and perform the treatments religiously every day. My mother sure did. She truly thought her doctor of many years was working on getting her well. She did not realize she was dying right on schedule and this was the reason he was not upset with her deterioration.


Gold Standard

GOLD is an acronym that stands for the Global Initiative on Obstructive Lung Disease. Their emphysema staging is a good standard for determining where you are on the timeline as it provides quantifiable benchmarks. GOLD is the most common staging system used however, the BODE system is more accurate.

Emphysema Staging According to GOLD

GOLD divides emphysema into four stages which are determined by symptoms and PFTs or Pulmonary Function Tests, the most common being the Spirometry Test.

The major factor in the GOLD emphysema staging is FEV1 or the Forced Expiratory Volume which is the amount of air an emphysema patient can forcefully exhale in one second.

Stage 1 Emphysema: Mild Emphysema
Patients with an FEV1 greater than or equal to 80% of normal.

Stage 2 Emphysema: Moderate Emphysema
Patients with an FEV1 greater than or equal to 50% of normal but less than 80% of normal.

Stage 3 Emphysema: Severe Emphysema
Patients with an FEV1 greater than or equal to 30% of normal but less than 50% of normal.

Stage 4 Emphysema: Very Severe Emphysema
Patients with an FEV1 less than 30% of normal or a patient with "low blood oxygen levels" that is less than 50% of normal.

Other emphysema staging protocols group Stage 3 and 4 together as stage 4 and list "At Risk" as the first stage. At risk are those patients that have a normal spirometry reading however, they have a chronic cough and above normal sputum production.

While the GOLD standard for emphysema staging is widely used and relatively accurate in determining which emphysema stage the patient is in, additional factors may need inclusion for increased accuracy when determining a patient's actual prognosis.

BODE System

The BODE Emphysema Staging System provides a more accurate prognosis than the GOLD system because it includes additional factors such as body mass index and exercise capacity along with taking into account airflow limitation and breathlessness or dyspnea.

These four factors are assessed in the following way:

  1. Body Mass Index (B) - weight adjusted for height.
  2. Airflow Limitation or Obstruction (O)- measured by Pulmonary Function Test.
  3. Breathlessness or Dyspnea (D) - assessed by a questionnaire.
  4. Exercise Capacity (E)- measured by the distance an emphysema patient can walk in six minutes.



Spirometry is the most sensitive and commonly used Pulmonary Function Test for determining lung capacity and function and ultimately the emphysema stage a patient is in. It can detect mild emphysema long before significant symptoms appear.

For additional information follow the link above to Mayo Clinic. The last page of their article describes the FEV1 and the FVC, or Forced Vital Capacity.


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