Global Initiative for Obstructive Lung Disease (GOLD) Criteria for COPD
Treatment recommendations based on COPD stage.
Global ABE Assessment Tool
- The number of acute symptomatic deteriorations of COPD over the past 12 months requiring either increased medical management with or without hospitalization.
Reference
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
| GRADE | FEV1 (% predicted) |
| GOLD 1 | ≥80 |
| GOLD 2 | 50-79 |
| GOLD 3 | 30-49 |
| GOLD 4 | <30 |
| GROUP | CRITERIA |
| A |
AND
|
| B |
AND
|
| E |
AND
|
| E (Eos ≥300) |
AND
|
RECOMMENDATIONS
GOLD GROUP | RISK | PHARMACOLOGIC TREATMENT | NONPHARMACOLOGIC TREATMENT |
| A | Low risk, low exacerbation frequency, no hospitalizations, low symptom burden. | Bronchodilator |
|
| B | Low risk, low exacerbation frequency, no hospitalizations, increase symptom burden. | Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA) |
|
| C | High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden. | Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA) |
|
| E | High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden. |
|
|
| E (Eos ≥300) | High risk, increased exacerbation frequency leading to hospitalization, variable symptom burden. |
|
|
GLOBAL RECOMMENDATIONS
Goals for Treatment of Stable COPD:
- Reduce Symptoms
- Relieve Symptoms
- Improve Exercise Tolerance
- Improve Health Status
- Reduce Risk
- Prevent Disease Progression
- Prevent & Treat Exacerbations
- Reduce Mortality
Review:
- Risk factor management
- ∝1-antitrypsin
- blood eosinophil count
- exposures/irritants
- Inhaler technique & adherence
- Self management skills
- breathlessness
- written action plan
- Need for oxygen, NIV, lung volume reduction, palliative approaches
- Management of comorbidities
- Spirometry (at least annually)
Refer to the 2024 guidelines for more information.
Instructions
- 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.
Literature
- Global Initiative for Chronic Obstructive Lung Disease - GOLD. 2024 GOLD Report. — 2024 Global Initiative for COPD
- 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.
- 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.
- 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.
- 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.
- 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.
- Jennifer Glen , DNP, FNP-BC — EVAL Health, Chief Medical Officer