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Global Initiative for Obstructive Lung Disease (GOLD) Criteria for COPD

Treatment recommendations based on COPD stage.

المبتكِرGlobal Initiative For Chronic Obstructive Lung Disease (GOLD)
تجربة
المفضلة
التعليمات

  •  Intended for patients > 18 years old with a current COPD diagnosis by spirometry (FEV2/FVC <0.7) and history.

  • Do not use the GOLD criteria to diagnose COPD.

  • Do not use in patients with acute exacerbation.

Global ABE Assessment Tool

Global ABE Assessment Process2024 Global Initiative for COPD

 The Global Initiative for Chronic Obstructive Pulmonary Lung Disease (GOLD) Criteria were first published in 2001 to assist clinicians in assessing and characterizing the severity of Chronic Obstructive Pulmonary Disease (COPD). Once COPD is diagnosed by spirometry (FEV1/FVC <0.7), the GOLD Criteria can be used to predict the risk of future COPD exacerbations and classify patients into therapeutic treatment groups (A,B & E). The Global ABE Assessment Process includes assessment of airflow obstruction by stage (GOLD 1-4) based on FEV1. The final step involves two dyspnea scales called the COPD Assessment Test (CAT) or the Modified Medical Research Council (mMRC) Dyspnea Scale in conjunction with the patient's exacerbation history to guide therapeutic interventions for management of stable, baseline COPD. In addition, the Global ABE Assessment includes the use of blood eosinophils to assist in identifying high risk patients that may benefit from additional Inhaled Corticosteroid (ICS) therapy.

Of note, the Global ABE Assessment Process:

  • Intended for patients > 18 years old with a current COPD diagnosis by spirometry (FEV2/FVC <0.7) and history.

  • Do not use the GOLD criteria to diagnose COPD.

  • Do not use in patients with acute exacerbation. Refer to the GOLD guidelines for management of acute exacerbations.

 

FORMULA

GRADE

FEV1 (% predicted)

GOLD 1

≥80

GOLD 2

50-79

GOLD 3

30-49

GOLD 4

<30

 

GROUP

CRITERIA

A

  • 0 OR 1 moderate (not leading to hospitalization) exacerbations

                                                  AND

  • mMRC 0-1 OR CAT <10

B

  • 0 OR 1 moderate (not leading to hospitalization) exacerbations

                                                  AND

  • mMRC ≥2 OR CAT ≥10

E

  • ≥2 moderate OR ≥1 leading to hospitalization exacerbations

                                                  AND

  • Eos ≤ 300 OR unknown

E (Eos  ≥300) 

  • ≥2 moderate OR ≥1 leading to hospitalization exacerbations

                                                  AND

  • Eos ≥ 300 

 

RECOMMENDATIONS

GOLD 

GROUP

RISK

PHARMACOLOGIC TREATMENT

NONPHARMACOLOGIC TREATMENT

A

Low risk, low exacerbation frequency, no hospitalizations, low symptom burden.

Bronchodilator

  • Essential: Smoking Cessation

  • Recommended: Physical Activity

  • Depending on Local Guidelines:

    • Influenza vaccination

    • COVID-19 vaccinations

    • Pneumococcal vaccination

    • Pertussis vaccination

    • Shingles vaccination

    • RSV vaccination

 

B

Low risk, low exacerbation frequency, no hospitalizations, increase symptom burden.

Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

  • Essential: Smoking Cessation

  • Recommended: 

    • Physical Activity

    • Pulmonary Rehabilitation

  • Depending on Local Guidelines:

    • Influenza vaccination

    • COVID-19 vaccinations

    • Pneumococcal vaccination

    • Pertussis vaccination

    • Shingles vaccination

    • RSV vaccination

C

High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

  • Essential: Smoking Cessation

  • Recommended: 

    • Physical Activity

    • Pulmonary Rehabilitation

  • Depending on Local Guidelines:

    • Influenza vaccination

    • COVID-19 vaccinations

    • Pneumococcal vaccination

    • Pertussis vaccination

    • Shingles vaccination

    • RSV vaccination

E

High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

  1. Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

  • Essential: Smoking Cessation

  • Recommended: 

    • Physical Activity

    • Pulmonary Rehabilitation

  • Depending on Local Guidelines:

    • Influenza vaccination

    • COVID-19 vaccinations

    • Pneumococcal vaccination

    • Pertussis vaccination

    • Shingles vaccination

    • RSV vaccination

E (Eos  ≥300)

High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

  1. Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

  2. AND Inhaled corticosteroid (ICS)

  • Essential: Smoking Cessation

  • Recommended: 

    • Physical Activity

    • Pulmonary Rehabilitation

  • Depending on Local Guidelines:

    • Influenza vaccination

    • COVID-19 vaccinations

    • Pneumococcal vaccination

    • Pertussis vaccination

    • Shingles vaccination

    • RSV vaccination

 

GLOBAL RECOMMENDATIONS

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms

    1. Relieve Symptoms

    2. Improve Exercise Tolerance

    3. Improve Health Status

  2. Reduce Risk

    1. Prevent Disease Progression

    2. Prevent & Treat Exacerbations

    3. Reduce Mortality

 

Review:

  1. Risk factor management

    1. ∝1-antitrypsin

    2. blood eosinophil count

    3. exposures/irritants

  2. Inhaler technique & adherence

  3. Self management skills

    1. breathlessness

    2. written action plan

  4. Need for oxygen, NIV, lung volume reduction, palliative approaches

  5. Management of comorbidities

  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

جميع الأسئلة والنتائج المحتملة

Global ABE Assessment Tool
FEV1% of predicted

Select one option:

  • ≥80 (GOLD 1: Mild)
  • 50-79 (GOLD 2: Moderate)
  • 30-49 (GOLD 3: Severe)
  • <30 (GOLD 4: Very Severe)
Exacerbation history
  • The number of acute symptomatic deteriorations of COPD over the past 12 months requiring either increased medical management with or without hospitalization.

 

Select one option:

  • 0 exacerbations
  • 1 exacerbation without hospital admission
  • ≥ 1 exacerbation with hospital admission
  • ≥2 exacerbations
Choose a dyspnea scale

Select one option:

  • mMRC (1-question tool)
  • CAT (8-question tool)
Eosinophil countالعنوان غير مرئي
Blood eosinophils ≥300 cells/µl

Select one option:

  • Yes
  • No
  • Unknown
Default Sectionالعنوان غير مرئي
Cough

On a scale of 0 to 5. No symptoms is 0 and the most severe is 5.

 

Select one option:

  • 0 "I never cough"
  • 1
  • 2
  • 3
  • 4
  • 5 "I cough all the time"
Phlegm

On a scale of 0 to 5. No symptoms is 0 and the most severe is 5.

 

Select one option:

  • 0 "I have no phlegm in my chest at all"
  • 1
  • 2
  • 3
  • 4
  • 5 "My chest is completely full of phlegm"
Chest tightness

On a scale of 0 to 5. No symptoms is 0 and the most severe is 5.

 

Select one option:

  • 0 "My chest does not feel tight at all"
  • 1
  • 2
  • 3
  • 4
  • 5 "My chest feels very tight"
Breathlessness

On a scale of 0 to 5. No symptoms is 0 and the most severe is 5.

 

Select one option:

  • 0 "When I walk up a hill or one flight of stairs I am not breathless"
  • 1
  • 2
  • 3
  • 4
  • 5 "When walk up a hill or one flight of stairs I am very breathless"
Activities

On a scale of 0 to 5. No symptoms is 0 and the most severe is 5.

 

Select one option:

  • 0 "I am not limited doing any activities at home"
  • 1
  • 2
  • 3
  • 4
  • 5 "I am very limited doing any activities at home"
Confidence

On a scale of 0 to 5. No symptoms is 0 and the most severe is 5.

 

Select one option:

  • 0 "I am confident leaving my home despite my lung condition"
  • 1
  • 2
  • 3
  • 4
  • 5 "I am not at all confident leaving my home because of my lung condition"
Sleep

On a scale of 0 to 5. No symptoms is 0 and the most severe is 5.

 

Select one option:

  • 0 "I sleep soundly"
  • 1
  • 2
  • 3
  • 4
  • 5 "I do not sleep soundly because of my lung condition"
Energy

On a scale of 0 to 5. No symptoms is 0 and the most severe is 5.

 

Select one option:

  • 0 "I have lots of energy"
  • 1
  • 2
  • 3
  • 4
  • 5 "I have no energy at all"
Default Sectionالعنوان غير مرئي
Symptom Severity
  • Walking ought to be assessed on level ground

 

Select one option:

  • Dyspnea only with strenuous exercise
  • Dyspnea when hurrying or walking up a slight hill
  • Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace
  • Stops for breath after walking 100 yards (91 m) or after a few minutes
  • Too dyspneic to leave the house or breathless when dressing
النتائج المحتملة
Grade 4 airflow obstruction & GOLD B group

Risk: Low risk, low exacerbation frequency, no hospitalizations, increase symptom burden.

 

Pharmacologic treatment recommendation: Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 3 airflow obstruction & GOLD B group

Risk: Low risk, low exacerbation frequency, no hospitalizations, increase symptom burden.

 

Pharmacologic treatment recommendation: Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 2 airflow obstruction & GOLD E group with eosinophils ≥300

Risk: High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

 

Pharmacologic treatment recommendation: 

  1. Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)
  2. AND Inhaled corticosteroid (ICS)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 3 airflow obstruction & GOLD A group

Risk: Low risk, low exacerbation frequency, no hospitalizations, low symptom burden.

 

Pharmacologic treatment recommendation: Bronchodilator

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines
Smoking CessationPhysical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

 

Grade 4 airflow obstruction & GOLD E group with eosinophils ≥300

Risk: High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

 

Pharmacologic treatment recommendation: 

  1. Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)
  2. AND Inhaled corticosteroid (ICS)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 3 airflow obstruction & GOLD E group with eosinophils ≥300

Risk: High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

 

Pharmacologic treatment recommendation: 

  1. Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)
  2. AND Inhaled corticosteroid (ICS)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 1 airflow obstruction & GOLD A group

Risk: Low risk, low exacerbation frequency, no hospitalizations, low symptom burden.

 

Pharmacologic treatment recommendation: Bronchodilator

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines
Smoking CessationPhysical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 4 airflow obstruction & GOLD A group

Risk: Low risk, low exacerbation frequency, no hospitalizations, low symptom burden.

 

Pharmacologic treatment recommendation: Bronchodilator

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines
Smoking CessationPhysical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

 

Grade 2 airflow obstruction & GOLD B group

Risk: Low risk, low exacerbation frequency, no hospitalizations, increase symptom burden.

 

Pharmacologic treatment recommendation: Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 1 airflow obstruction & GOLD E group with eosinophils ≥300

Risk: High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

 

Pharmacologic treatment recommendation: 

  1. Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)
  2. AND Inhaled corticosteroid (ICS)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 2 airflow obstruction & GOLD E group

Risk: High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

 

Pharmacologic treatment recommendation: Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 2 airflow obstruction & GOLD A group

Risk: Low risk, low exacerbation frequency, no hospitalizations, low symptom burden.

 

Pharmacologic treatment recommendation: Bronchodilator

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines
Smoking CessationPhysical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 1 airflow obstruction & GOLD E group

Risk: High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

 

Pharmacologic treatment recommendation: Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 1 airflow obstruction & GOLD B group

Risk: Low risk, low exacerbation frequency, no hospitalizations, increase symptom burden.

 

Pharmacologic treatment recommendation: Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

 

Grade 4 airflow obstruction & GOLD E group

Risk: High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

 

Pharmacologic treatment recommendation: Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

Grade 3 airflow obstruction & GOLD E group

Risk: High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.

 

Pharmacologic treatment recommendation: Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)

*See slide #33 of the teaching slide deck for a list of commonly used COPD medications.

 

Non-pharmacologic treatment recommendations:

 

Essential                      Recommended     Depending on Local Guidelines

Smoking Cessation

Pulmonary rehabilitation  

Physical Activity

Influenza vaccination

COVID-19 vaccinations

Pneumococcal vaccination

Pertussis vaccination

Shingles vaccination

RSV vaccination

 

Goals for Treatment of Stable COPD:

  1. Reduce Symptoms
    1. Relieve Symptoms
    2. Improve Exercise Tolerance
    3. Improve Health Status
  2. Reduce Risk
    1. Prevent Disease Progression
    2. Prevent & Treat Exacerbations
    3. Reduce Mortality

 

Review:

  1. Risk factor management
    1. ∝1-antitrypsin
    2. blood eosinophil count
    3. exposures/irritants
  2. Inhaler technique & adherence
  3. Self management skills
    1. breathlessness
    2. written action plan
  4. Need for oxygen, NIV, lung volume reduction, palliative approaches
  5. Management of comorbidities
  6. Spirometry (at least annually)

 

Refer to the 2024 guidelines for more information.

 

 

CAT Score indicates HIGH health impact (21-30 points)
  • The Global Initiative for Obstructive Lung Disease (GOLD) treatment guidelines include the CAT and the Modified Medical Research Council (mMRC) Dyspnea Scale score as components of a multi-faceted assessment and treatment approach to patients with COPD.
  • The CAT is combined with other dyspnea measurements, such as the mMRC Dyspnea Scale score, the patient's FEV1 precent predicted and the frequency of COPD exacerbations to guide treatment interventions.  
CAT Score indicates VERY HIGH health impact (31-40 points)
  • The Global Initiative for Obstructive Lung Disease (GOLD) treatment guidelines include the CAT and the Modified Medical Research Council (mMRC) Dyspnea Scale score as components of a multi-faceted assessment and treatment approach to patients with COPD.
  • The CAT is combined with other dyspnea measurements, such as the mMRC Dyspnea Scale score, the patient's FEV1 precent predicted and the frequency of COPD exacerbations to guide treatment interventions.  
CAT Score indicates LOW health impact (0-10 points)
  • The Global Initiative for Obstructive Lung Disease (GOLD) treatment guidelines include the CAT and the Modified Medical Research Council (mMRC) Dyspnea Scale score as components of a multi-faceted assessment and treatment approach to patients with COPD.
  • The CAT is combined with other dyspnea measurements, such as the mMRC Dyspnea Scale score, the patient's FEV1 precent predicted and the frequency of COPD exacerbations to guide treatment interventions.  
CAT Score indicates MEDIUM health impact (11-20 points)
  • The Global Initiative for Obstructive Lung Disease (GOLD) treatment guidelines include the CAT and the Modified Medical Research Council (mMRC) Dyspnea Scale score as components of a multi-faceted assessment and treatment approach to patients with COPD.
  • The CAT is combined with other dyspnea measurements, such as the mMRC Dyspnea Scale score, the patient's FEV1 precent predicted and the frequency of COPD exacerbations to guide treatment interventions.  
Dyspnea Grade 1 (out of 4)
  • Higher grade indicates higher severity.
  • The mMRC Dyspnea Scale score must be part of a comprehensive assessment, to include the patient's history, physical, and diagnostic test results.
Dyspnea Grade 0 (out of 4)
  • Higher grade indicates higher severity.
  • The mMRC Dyspnea Scale score must be part of a comprehensive assessment, to include the patient's history, physical, and diagnostic test results.
Dyspnea Grade 4 (out of 4)
  • Higher grade indicates higher severity.
  • The mMRC Dyspnea Scale score must be part of a comprehensive assessment, to include the patient's history, physical, and diagnostic test results. 
  • Consider spirometry (e.g., FEV1 and FVC), determining the GOLD stage, and pursuing relevant diagnostic or therapeutic interventions as appropriate if the mMRC score is ≥ 2.
Dyspnea Grade 2 (out of 4)
  • Higher grade indicates higher severity.
  • The mMRC Dyspnea Scale score must be part of a comprehensive assessment, to include the patient's history, physical, and diagnostic test results. 
  • Consider spirometry (e.g., FEV1 and FVC), determining the GOLD stage, and pursuing relevant diagnostic or therapeutic interventions as appropriate if the mMRC score is ≥ 2.
Dyspnea Grade 3 (out of 4)
  • Higher grade indicates higher severity.
  • The mMRC Dyspnea Scale score must be part of a comprehensive assessment, to include the patient's history, physical, and diagnostic test results. 
  • Consider spirometry (e.g., FEV1 and FVC), determining the GOLD stage, and pursuing relevant diagnostic or therapeutic interventions as appropriate if the mMRC score is ≥ 2.

الاستشهاد المرجعي

Global Initiative for Chronic Obstructive Lung Disease. "Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. NHLBI/WHO Workshop Report." Bethesda: National Heart, Lung, and Blood Institute; 2001. NIH Publication No. 2701.

الأدبيات العلمية

  • Global Initiative for Chronic Obstructive Lung Disease - GOLD. 2024 GOLD Report.

    2024 Global Initiative for COPD

    https://goldcopd.org/2024-gold-report/

  • Chronic obstructive pulmonary disease in the older adult: what defines abnormal lung function? Thorax. 2007 Mar;62(3):237-41.

    Mannino DM, Sonia Buist A, Vollmer WM.

    https://pubmed.ncbi.nlm.nih.gov/17090573/

  • Do GOLD stages of COPD severity really correspond to differences in health status? Eur Respir J. 2003 Sep;22(3):444-9.

    Antonelli-Incalzi R, Imperiale C, Bellia V, Catalano F, Scichilone N, Pistelli R, Rengo F; SaRA Investigators.

    https://pubmed.ncbi.nlm.nih.gov/14516133/

  • Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013 Feb 15;187(4):347-65.

    Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R.

    https://pubmed.ncbi.nlm.nih.gov/22878278/

  • Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population. Am J Respir Crit Care Med. 2012 Nov 15;186(10):975-81.

    Lange P, Marott JL, Vestbo J, Olsen KR, Ingebrigtsen TS, Dahl M, Nordestgaard BG.

    https://pubmed.ncbi.nlm.nih.gov/22997207/

  • Distribution and prognostic validity of the new Global Initiative for Chronic Obstructive Lung Disease grading classification. Chest. 2013 Mar;143(3):694-702.

    Soriano JB, Alfageme I, Almagro P, Casanova C, Esteban C, Soler-Cataluña JJ, de Torres JP, Martinez-Camblor P, Miravitlles M, Celli BR, Marin JM.

    https://pubmed.ncbi.nlm.nih.gov/23187891/

تقييمات ذات صلة

COPD Assessment Test (CAT)

Quantifies COPD symptom burden on patients' functional status

Dr. Paul W. Jones, MD, PhD

mMRC (Modified Medical Research Council) Dyspnea Scale

Stratifies severity of dyspnea in respiratory diseases, such as COPD.

Dr. Donald A. Mahler, MD

PSI/PORT Score: Pneumonia Severity Index for CAP

Risk stratification of community-acquired pneumonia to help determine inpatient versus outpatient treatment.

Dr. Michael J. Fine, MD, MSc

CURB-65 Score for Pneumonia Severity

Risk stratification of community-acquired pneumonia to help determine inpatient versus outpatient treatment.

Dr. Wee Shiong Lim, MBBS, MRCP, M.Med, MHPEd

STOP-BANG Score for Obstructive Sleep Apnea

Screens for obstructive sleep apnea

Dr. Frances Chung, MD, MBBS, LMCC, FRCPC

Asthma Inhaled Corticosteroid (ICS) Dose Strength Algorithm

Determine the strength (low, med, high) of an inhaled corticosteroid to correlate with an asthma therapy step.

The National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC)

Classify Asthma Severity

Assessing severity and initiating treatment for patients who are not currently taking long-term control medications

The National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC)

Assess Asthma Control & Adjust Therapy

Managing asthma long term

The National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC)

Identify Current Asthma Treatment Step

Determine your patient's current asthma treatment step based on current medications.

The National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC)

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Alcohol Use Disorders Identification Test - C (AUDIT-C)

A 3-item tool to screen for unhealthy alcohol use in patients who may not be alcohol-dependent.

Dr. Katharine Bradley, MD, MPH

Alcohol Use Disorders Identification Test (AUDIT)

A 10-item tool to screen for hazardous alcohol use, harmful use, and alcohol dependence.

World Health Organization Collaborative Project

American Shoulder and Elbow Surgeons (ASES) Shoulder Score

15-item assessment of shoulder pain and functional limitations in activities of daily living.

Dr. Robin R. Richards, MD, FRCSC, FAAOS, FAOA

Behavioral Activity Rating Scale (BARS)

A 1-item rating scale to quantify a patient's level of agitation in acute care or psychiatric settings.

Rachel H. Swift

Drug Abuse Screening Test (DAST-10)

A patient self-report questionnaire to screen for problematic drug use (excluding alcohol/tobacco).

Dr. Harvey A. Skinner, Ph.D.

Foot and Ankle Ability Measure (FAAM)

Assesses functional limitations and disability related to foot and ankle conditions in daily activities and sports.

Dr. Jesse Van Swearingen, PhD, PT, FAPTA

Foot and Ankle Disability Index (FADI)

Assess functional limitations of those with a variety of foot and ankle conditions

Dr. RobRoy Martin, PhD, PT, CSCS

General Anxiety Disorder (GAD-7)

Measure severity of anxiety

Dr. Robert L. Spitzer, MD
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