COPD Life Expectancy – Understanding GOLD Stages and the BODE Index

When you’re diagnosed with chronic obstructive pulmonary disease (COPD), it’s natural for your mind to immediately jump to the question of life expectancy. You may have already turned to Google only to find a sea of overwhelming and confusing information as you try to come across terms like “Stage 3 COPD” and “Group D COPD.”

Even turning to your doctor for answers about life expectancy can leave you feeling uncertain. While many patients want a simple "You have 5 years" chart, it just doesn't exist. COPD progression varies wildly, and diagnosis charts act as averages, not crystal balls. Many people live for decades with COPD.

Understanding how doctors commonly assess COPD progression and estimate life expectancy may put your prognosis into perspective and give you a sense of empowerment. The two main tools that physicians use when determining COPD progression and life expectancy include the:

• GOLD system

• BODE Index

In this article, we’ll explain how these two methods work, considerations to keep in mind for each one, and how you can take greater control over your health and future.

The Truth About the ‘COPD Life Expectancy Chart’

Unlike cancer, COPD is a chronic condition that progresses over a long period of time, and it is highly impacted by the patient’s lifestyle (such as smoking habits) and other health issues (such as heart conditions).

With COPD, life expectancy is typically reduced. However, with proper treatment and lifestyle changes such as smoking cessation, many patients can stay in the mild to moderate stages of COPD for longer, which can help minimize loss of life expectancy. Additionally, there are patients with more advanced stages of COPD who can live longer than expected.

Understanding GOLD Stages (The Lung Function Score)

The GOLD system uses a patient’s lung capacity combined to determine the progression of their COPD. With this system, the patient takes a spirometry test, which measures their forced expiratory volume in one second (FEV1), or how much air the patient can blow out within a minute. A doctor then considers these test results along with other factors–such as symptoms, the number of times symptoms seriously worsened, and the number of hospitalizations based on worsened symptoms–to assign a stage and determine the best treatment.

The GOLD system is a set of guidelines established by the Global Initiative for Chronic Obstructive Lung Disease for COPD diagnosis, management, and prevention, based on evidence-based strategy documents. It’s broken down into four stages:

The 4 GOLD Stages

While the COPD GOLD stages life expectancy method can be helpful for gauging disease progression, it’s important to remember these scores alone aren’t a perfect survival predictor, as there are Stage 3 COPD patients who may feel fine, and Stage 2 patients who may feel terrible.

Additionally, it should be noted that the accuracy of spirometry results can be compromised by factors such as:

• Poor patient effort

• Inadequate inhalation

• Difficulty following instructions

• Certain medical conditions

The BODE Index: A Better Predictor of Survival

The BODE Index is a multidimensional, comprehensive score that is used to determine the severity of COPD, predicting the likelihood of exacerbations (serious worsening of symptoms), hospitalizations, and mortality.

This score is based on four factors:

The BODE Index score is made up of points that range from 0 to 10, with 10 having the highest level of risk. The score is broken down into the following quartiles to determine survival rates (in a period of 52 months):

• Quartile 1 (0–2 points) – 82% survival rate

• Quartile 2 (3–4 points) – 69% survival rate

• Quartile 3 (5–6 points) – 60% survival rate

• Quartile 4 (7–10 points) – 25% survival rate

Unlike the GOLD system, which is focused on measuring lung function, the BODE Index is specifically designed to predict mortality risk, which can make it a more reliable method for estimating life expectancy. The BODE index also uses a more diverse range of factors, making it more of a “whole body” score than the GOLD system.

GOLD System vs. Bode Index

When comparing the two COPD assessment methods, it’s helpful to think of the GOLD stage system as assessing the engine (the impact of COPD on the lungs) and the BODE Index as measuring the whole car (the impact of COPD on the body’s core systems).

A more holistic look at disease progression can allow for more comprehensive treatment. For example, a car with a bad engine can still run for a long time if other parts of the vehicle (like the tires and chassis) are kept in good condition. 

Factors That Change Your Numbers (the Variables)

While some scores may be more aligned with certain stages of COPD (and therefore certain estimated survival rates or life expectancies), it’s important to remember that they can be highly variable depending on each patient’s unique circumstances—and those circumstances can change over time. Some factors that can impact your scores include the following. 

Smoking

Smoking is one of the leading causes of COPD, with tobacco smoking being responsible for more than 70% COPD cases in high-income countries, according to the World Health Organization. So it makes sense that smoking would have a major impact on progression of COPD for those who are already diagnosed with the disease.

Quitting smoking is the most effective and cost-effective form of COPD treatment. When COPD patients stop smoking, they can pause the oops rapid decline of COPD, whereas continued smoking can accelerate it.

Exacerbations (or flare-ups)

One study found that the loss of life expectancy for patients with a history of severe acute exacerbations (or serious COPD flare-ups) almost matched the loss of life expectancy for patients with more advanced COPD (GOLD grades 3 and 4). Both groups had loss of life in the range of eight to nine years.

The past occurrence of acute exacerbations and hospitalizations should be taken into account when estimating life expectancy. Your best line of defense is to take proactive steps to prevent flare-ups occurring. 

Comorbidities

Other health conditions like heart disease, diabetes, and osteoporosis can worsen COPD symptoms, make the patient more prone to hospitalizations, and lower survival rates. This is why more holistic assessments that consider the impact of COPD on the whole body are so important.

Encourage your doctor to use a COPD progression assessment method that properly takes comorbidities into consideration, and make sure you’re taking preventative measures to keep your various conditions from flaring up and aggravating one another.

Can You Improve Your Outlook?

While you cannot reverse the lung damage that occurs with COPD or cure your condition, you can take steps to improve your BODE Index score, which means you may be on track to prolong your lifespan. Some of those preventative actions include the following:

Maintain a normal BMI

Being overweight or underweight (and therefore having a low or high BMI) can negatively impact lung function. Meanwhile, normal BMI levels have been found to reduce the risk of flare-ups and even death.

Maintain a healthy diet to help ensure your body has enough energy for more labored breathing and can maintain the right level of muscle mass. Review the American Lung Association’s nutrition recommendations for people with COPD.

Get regular exercise

In addition to helping COPD patients control their weight and BMI, regular modest exercise can also help them improve oxygen usage, bolster cardiovascular health, strengthen muscles, and more. All of this can help COPD patients improve their overall health and increase their walking distance, better preparing them for the “exercise capacity” portion of the BODE Index test.

Pulmonary rehabilitation is a great way for patients to build both physical stamina and awareness, as it combines patient education, exercise, and lifestyle changes into a single program–which is important since lifestyle habits and COPD progression often go hand-in-hand.

Control dyspnea symptoms

While complications from COPD are the cause of shortness of breath, dyspnea can quickly become a downward spiral that further harms your health. This is because dyspnea can cause added strain on your lungs (such as through hyperinflation), limit physical activity (which can lead to muscle loss and other physical deterioration), and trigger anxiety and depression. Regularly taking your prescribed medications, such as an inhaler, can help you better control your breathing and your health.

COPD Life Expectancy Frequently Asked Questions (FAQs)

The future can feel less scary when you’re equipped with knowledge. Here are some answers to commonly asked questions about COPD life expectancy, which can help you feel more informed and prepared for future testing, care, and disease management.

Is GOLD Stage 4 a death sentence?

While GOLD Stage 4 is the most severe stage of COPD, this does not necessarily mean that life will immediately come to end for a diagnosed patient. Considering how variable this disease is, many people can live for years in Stage 4 with proper oxygen therapy, care, and lifestyle changes. Most people reach Stage 4 after many years of having COPD.

What is FEV1 in COPD?

FEV1 (or forced expiratory volume in one second) refers to the amount of air you can push out of your lungs in the first second when you take a deep breath. FEV1 is one of the most common parameters used in spirometry, which measures patients’ lung capacity for the purposes of diagnosing and assessing COPD.

How accurate is the BODE index?

Studies have shown the BODE Index to be more effective than the FEV1 method alone for predicting flare-ups and mortality in COPD patients. This method of measurement is typically seen as being more reliable due to its diverse range of measurement factors that extend beyond lung function, looking at both the pulmonary (having to do with the lungs) and systemic (overall) impact of COPD.

Additionally, the BODE Index was specifically created for the purpose of predicting risk of mortality. In fact, because of its strength in risk prediction, the BODE Index has been recommended for use in more high-risk COPD patients, particularly those with increased likelihood of exacerbations, complications, or mortality.

Looking to the Future When You Have COPD

At the end of the day, the important thing to remember is that your COPD stage doesn’t define you or what the remainder of your life will look like. While the GOLD system and BODE Index are meant to serve as guide posts following a COPD diagnosis, they aren’t a one-size-fits all approach. A GOLD Stage 3 patient who exercises regularly, and doesn't smoke often outlives a Stage 2 patient who is sedentary and smokes.

Focus on what you can control: your activity level, your diet, and your smoking status. You may have more say over your future than you realize.