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Chest. 2006 Sep;130(3):666-71.

Physician-diagnosed COPD global initiative for chronic obstructive lung disease stage IV in Ostersund, Sweden: Patient characteristics and estimated prevalence.

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Department of Respiratory Medicine & Allergy, Ostersund Hospital, 83183 Ostersund, Sweden.



The prevalence of COPD is estimated to 4 to 14%. According to the Global Initiative for Chronic Obstructive Lung Disease guidelines, COPD is divided into four stages. Patients with stage IV disease (very severe) have FEV1 < 30% of predicted values and/or respiratory insufficiency. The few studies that exist have reported a stage IV disease prevalence of 0.1 to 0.2% but provide limited additional patient characteristics. The present study estimated the prevalence of physician-diagnosed stage IV COPD in the city of Ostersund, Sweden, and characterized the patients.


Due to the regional integrated care pathway, patients in whom severe COPD is diagnosed are under surveillance by the Respiratory Department at Ostersund Hospital. Among these patients and all others in whom COPD has been diagnosed at Ostersund Hospital from 2000 to 2004, all those with an FEV1 of < 40% predicted were examined.


A total of 76 patients fulfilled the criteria for stage IV COPD. The mean age was 71 years, 59% were women, and 40% were receiving long-term oxygen therapy. Sixty-five percent of the patients lived independently at home, 9% were present smokers, and 75% used inhaled corticosteroids daily. Sixty-seven percent of the patients had received vaccination against influenza the previous year. During 2004, 48% of the patients had at least one COPD-related hospitalization, and 11% had made at least one visit to the hospital for emergency care.


The present study indicated that 0.13% of the population in Ostersund in 2004 had physician-diagnosed stage IV COPD. This is probably an underestimation of the true prevalence. Patients with stage IV COPD appear to require periods of hospitalization more often than intermittent emergency department visits.

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