Global Initiative for Obstructive Lung Disease (GOLD) Criteria for COPD
Treatment recommendations based on COPD stage.
Jennifer Glen
Provided by
EVAL FoundationInstructions
- 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
- The number of acute symptomatic deteriorations of COPD over the past 12 months requiring either increased medical management with or without hospitalization.
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.
All questions & possible results
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 countTitle not visible
Blood eosinophils ≥300 cells/µl
Select one option:
- Yes
- No
- Unknown
Default SectionTitle not visible
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 SectionTitle not visible
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
Possible results
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:
- 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.
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:
- 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.
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:
- Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)
- 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:
- 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.
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 Cessation | Physical Activity | Influenza vaccination COVID-19 vaccinations Pneumococcal vaccination Pertussis vaccination Shingles vaccination RSV vaccination |
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.
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:
- Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)
- 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:
- 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.
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:
- Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)
- 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:
- 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.
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 Cessation | Physical Activity | Influenza vaccination COVID-19 vaccinations Pneumococcal vaccination Pertussis vaccination Shingles vaccination RSV vaccination |
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.
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 Cessation | Physical Activity | Influenza vaccination COVID-19 vaccinations Pneumococcal vaccination Pertussis vaccination Shingles vaccination RSV vaccination |
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.
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:
- 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.
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:
- Long-acting bronchodilator (LABA) AND long-acting methacholine antagonist (LAMA)
- 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:
- 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.
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:
- 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.
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 Cessation | Physical Activity | Influenza vaccination COVID-19 vaccinations Pneumococcal vaccination Pertussis vaccination Shingles vaccination RSV vaccination |
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.
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:
- 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.
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:
- 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.
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:
- 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.
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:
- 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.
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.
Literature
- Global Initiative for Chronic Obstructive Lung Disease - GOLD. 2024 GOLD Report. — 2024 Global Initiative for COPD
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