Global_Initiative_for_Obstructive_Lung_Disease_GOLD_Criteria_for_COPD_guideline v.1
The GOLD Criteria are used clinically to determine the severity of expiratory airflow obstruction for patients with COPD. Determining a patient’s GOLD status requires a multidimensional assessment of a patient’s spirometry, symptom burden, and frequency of COPD exacerbations. Spirometry is measured by formal pulmonary function testing, and the percent predicted of the forced expiratory volume in 1 second (FEV₁) is the value used in calculating a patient’s GOLD status. Symptom burden is quantified by either the modified Medical Research Council (mMRC) Dyspnea Scale or COPD assessment test (CAT) score. Exacerbation frequency encompasses the number of acute symptomatic deteriorations of COPD over the past 12 months requiring either increased medical management or hospitalization.
Predicts risk of future COPD exacerbations (Lange and Soriano) and mortality (Lange, Leivseth, and Soriano). Can serve as a framework to discuss disease management and risk reduction for patients with COPD. GOLD stages are linked to specific therapeutic recommendations for medical management for both chronic COPD, as well as suggestions for acute exacerbations. Derived from and described in a global patient population, implying relevancy for use in a wide variety of clinical and geographic settings.
The GOLD Criteria can be used in patients with COPD with recent spirometry results available in the ambulatory setting who are at their baseline with regard to symptoms and lung function.GOLD 1–4 refers to the grade of airflow obstruction, and GOLD A-D are the groups on which treatment recommendations are based. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Post-bronchodilator FEV1/FVC<0.7= Grade: FEV1(%predicted): GOLD1=≥80, GOLD 2=50-79, GOLD 3=30-49, GOLD 4= <30. Group A: 0 exacerbations OR 1 exacerbation without hospital admission AND mMRC 0-1 or CAT <10.3-year mortality 3.8%, Pharmacologic treatment recommendation is Bronchodilator (long- or short-acting). Group B: 0 exacerbations OR 1 exacerbation without hospital admission AND mMRC ≥2 or CAT ≥10. 3-year mortality 10.6%, Pharmacologic treatment recommendation is Long-acting bronchodilator (LABA) or long-acting methacholine antagonist (LAMA). Group C: ≥1 exacerbation with hospital admission OR ≥2 exacerbations AND mMRC 0-1 or CAT <10. 3-year mortality 8.2%, Pharmacologic treatment recommendation is LAMA (or LAMA + LABA, or LABA + ICS (inhaled corticosteroids) if frequent exacerbations). Group D: ≥1 exacerbation with hospital admission OR ≥2 exacerbations AND mMRC ≥2 or CAT ≥10. 3-year mortality 20.1%, Pharmacologic treatment recommendation is LAMA and LABA, plus inhaled corticosteroid (ICS) if frequent exacerbations.
The GOLD Criteria were developed and primarily validated for patients >18 years of age. Do not use in patients suffering an acute exacerbation or worsening of respiratory symptoms. Should not be used to diagnose COPD, but rather to categorize clinical severity to inform prognosis and to guide therapeutic interventions.
Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management of Chronic Obstructive Pulmonary Diseases; NHLBI Workshop report 2003. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management of Chronic Obstructive Pulmonary Diseases; NHLBI Workshop report 2017. Petsonk, E. L., Hnizdo, E., AND Attfield, M. (2007). Definition of COPD GOLD stage I. Thorax, 62(12), 1107–1109. Mannino, D. M., Sonia Buist, A., AND Vollmer, W. M. (2007). Chronic obstructive pulmonary disease in the older adult: what defines abnormal lung function?. Thorax, 62(3), 237–241. https://doi.org/10.1136/thx.2006.068379. Lange, P., Marott, J. L., Vestbo, J., Olsen, K. R., Ingebrigtsen, T. S., Dahl, M., AND Nordestgaard, B. G. (2012). Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population. American journal of respiratory and critical care medicine, 186(10), 975-981.
OBSERVATION.global_initiative_for_obstructive_lung_disease_gold_criteria_for_copd.v0, EVALUATION.global_initiative_for_obstructive_lung_disease_gold_criteria_for_copd.v0
