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    Chief Complaint


    Organ System


    Patent Pending

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

    Assesses different stages of COPD and provides treatment recommendations.


    Use in patients >18 years of age with already-diagnosed COPD by spirometry (FEV₁/FVC <0.7) with baseline symptoms and lung function. Do not use to diagnose COPD and do not use in patients with acute exacerbation.

    When to Use
    Why Use
    • Patients with COPD with recent spirometry results available in the ambulatory setting who are at their baseline with regard to symptoms and lung function.
    • Do not use in patients suffering an acute exacerbation or worsening of respiratory symptoms.
    • The GOLD Criteria were developed and primarily validated for patients >18 years of age.
    • The GOLD Criteria are used clinically to determine the severity of expiratory airflow obstruction for patients with COPD.
    • Should not be used to diagnose COPD, but rather to categorize clinical severity to inform prognosis and to guide therapeutic interventions.
    • 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.
    • GOLD status (A-D) explicitly guides therapeutic interventions for management of stable, baseline COPD, with GOLD A patients requiring less medical management than GOLD D patients.
    • The 2017 GOLD Criteria predict mortality risk for patients with COPD, but not more accurately than the earlier GOLD scores (Leivseth and Soriano).
    • Stage B may predict higher mortality than stage C COPD, as determined by the 2011 GOLD Criteria (Lange).
    • GOLD status in the 2011 criteria does predict risk of exacerbation better than the older, spirometrically-based GOLD Criteria (Lange and Soriano).
    • GOLD stages B, C, and D do not accurately reflect patient’s functional status as measured by 6 minute walk testing, London Chest Activities of Daily Living Scale, or daily life activity monitoring (Moreira).
    • The therapeutic guidance coupled to GOLD stages is primarily based on expert consensus rather than direct evidence supporting specific therapeutic recommendations for a given GOLD stage; however, the individual medications and clinical interventions are supported by relatively strong level of evidence.
    • 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.
    Lower (mMRC <2 or CAT Score <10)
    Higher (mMRC ≥2 or CAT Score ≥10)
    0 exacerbations
    1 exacerbation without hospital admission
    ≥1 exacerbation with hospital admission
    ≥2 exacerbations


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    Creator Insights
    Dr. Edward Petsonk

    About the Creator

    Edward Petsonk, MD, is a professor of medicine at West Virginia University. He is a practicing pulmonologist and critical care physician and has been published in the literature on occupational deficits due to lung disease. Dr. Petsonk is also a retired captain in the US Public Health Service.

    To view Dr. Edward Petsonk's publications, visit PubMed

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    Content Contributors
    • Jeremy B. Richards, MD
    About the Creator
    Dr. Edward Petsonk
    Are you Dr. Edward Petsonk?
    Content Contributors
    • Jeremy B. Richards, MD