Summary
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 GRADEFEV1 (% predicted)GOLD 1≥80GOLD 250-79GOLD 330-49GOLD 4<30 GROUPCRITERIAA0 OR 1 moderate (not leading to hospitalization) exacerbations ANDmMRC 0-1 OR CAT <10B0 OR 1 moderate (not leading to hospitalization) exacerbations ANDmMRC ≥2 OR CAT ≥10E≥2 moderate OR ≥1 leading to hospitalization exacerbations ANDEos ≤ 300 OR unknownE (Eos ≥300) ≥2 moderate OR ≥1 leading to hospitalization exacerbations ANDEos ≥ 300 RECOMMENDATIONS GOLD GROUPRISKPHARMACOLOGIC TREATMENTNONPHARMACOLOGIC TREATMENTALow risk, low exacerbation frequency, no hospitalizations, low symptom burden.BronchodilatorEssential: Smoking CessationRecommended: Physical ActivityDepending on Local Guidelines:Influenza vaccinationCOVID-19 vaccinationsPneumococcal vaccinationPertussis vaccinationShingles vaccinationRSV vaccination BLow risk, low exacerbation frequency, no hospitalizations, increase symptom burden.Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)Essential: Smoking CessationRecommended: Physical ActivityPulmonary RehabilitationDepending on Local Guidelines:Influenza vaccinationCOVID-19 vaccinationsPneumococcal vaccinationPertussis vaccinationShingles vaccinationRSV vaccinationCHigh risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)Essential: Smoking CessationRecommended: Physical ActivityPulmonary RehabilitationDepending on Local Guidelines:Influenza vaccinationCOVID-19 vaccinationsPneumococcal vaccinationPertussis vaccinationShingles vaccinationRSV vaccinationEHigh risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)Essential: Smoking CessationRecommended: Physical ActivityPulmonary RehabilitationDepending on Local Guidelines:Influenza vaccinationCOVID-19 vaccinationsPneumococcal vaccinationPertussis vaccinationShingles vaccinationRSV vaccinationE (Eos ≥300)High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden.Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)AND Inhaled corticosteroid (ICS)Essential: Smoking CessationRecommended: Physical ActivityPulmonary RehabilitationDepending on Local Guidelines:Influenza vaccinationCOVID-19 vaccinationsPneumococcal vaccinationPertussis vaccinationShingles vaccinationRSV vaccination GLOBAL RECOMMENDATIONS Goals for Treatment of Stable COPD:Reduce SymptomsRelieve SymptomsImprove Exercise ToleranceImprove Health StatusReduce RiskPrevent Disease ProgressionPrevent & Treat ExacerbationsReduce Mortality Review:Risk factor management∝1-antitrypsinblood eosinophil countexposures/irritantsInhaler technique & adherenceSelf management skillsbreathlessnesswritten action planNeed for oxygen, NIV, lung volume reduction, palliative approachesManagement of comorbiditiesSpirometry (at least annually) Refer to the 2024 guidelines for more information.