Question 1

How often should spirometry be repeated in stable COPD?

Accepted Answer

At least annually. More frequently if the patient has a rapid decline in lung function or worsening symptoms. The FEV₁ decline in COPD averages approximately 30–60 mL/year, but varies widely between individuals.

Question 2

Does the GOLD grade predict mortality better than the BODE Index?

Accepted Answer

No — the BODE Index outperforms FEV₁ alone in predicting mortality because it captures systemic manifestations (exercise capacity, nutrition, dyspnoea). The GOLD grade remains essential for diagnosis and classification, but multidimensional tools like BODE give a better prognostic picture.

Question 3

Can a patient be GOLD Grade 4 (very severe) and still have few symptoms?

Accepted Answer

Yes — some patients adapt to their very severe obstruction by reducing activity (stoicism or the 'COPD iceberg' phenomenon). Always assess symptom burden (CAT or mMRC) alongside spirometric grade.