StageCharacteristicsTherapy
0: At riskChronic symptoms (cough, sputum production), exposure to risk factors (smoking), normal spirometryAvoidance of risk factors; annual influenza vaccine
I: MildFEV1/FVC < 70% predicted, FEV1 > 80% predicted, with or without symptomsAvoidance of risk factors; annual influenza vaccine; add short-acting bronchodilator as needed
II: ModerateFEV1/FVC < 70% predicted, FEV1 < 80% but > 50% predicted, with or without symptomsTreat with short-acting bronchodilator as needed plus one or two long-acting bronchodilators and pulmonary rehabilitation
III SevereFEV1/FVC < 70% predicted, FEV1 < 50% but > 30% predicted, with or without symptomsTreat with short-acting bronchodilator as needed, one or two long-acting bronchodilators and pulmonary rehabilitation; add inhaled glucocorticoids if repeated exacerbations
IV Very severeFEV1/FVC < 70% predicted, FEV1 < 30% OR FEV1 < 50% but with chronic respiratory failureTreat with short-acting bronchodilator as needed, one or two long-acting bronchodilators and pulmonary rehabilitation, inhaled glucocorticoids; add longterm oxygen if chronic respiratory failure, and consider surgical options