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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm





    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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    Next Steps
    Creator Insights


    • When clinically appropriate, patients with respiratory symptoms and risk factors for COPD should undergo spirometry to determine FEV₁ and FEV₁/FVC.
    • Patients meeting spirometric criteria for airways obstruction and clinical criteria for COPD should have their GOLD status determined.
    • Non-pharmacologic and pharmacologic treatments based on a patient’s GOLD stage should be considered and initiated as clinically appropriate (see Management below).
    • Referral to a pulmonologist should be considered for patients whose COPD is GOLD stage C or D, or patients with difficult-to-control symptoms or frequent COPD exacerbations regardless of GOLD stage.


    • Regardless of their GOLD stage, all patients with COPD should be counseled regarding risk reduction:
      • Education about the nature, prognosis, and outcomes of COPD should be emphasized in initial and subsequent patient visits.
      • Discussion of and recommendations about behavioral risk factors must be performed, including (primarily) smoking cessation and avoidance of secondhand smoke.
      • Avoidance of indoor and outdoor air pollution (including biomass fuel in appropriate settings), a potential trigger for a COPD exacerbation, should be emphasized.
      • Age- and clinically-appropriate vaccinations should be provided.
    • Next steps in therapeutic management are guided by the GOLD stage:
      • GOLD stage A: A bronchodilator should be offered (long- or short-acting as clinically indicated.) This medication should be continued if there is symptomatic response.
      • GOLD stage B: A long-acting bronchodilator (either a long-acting bronchodilator [LABA] or long-acting methacholine antagonist [LAMA]) should be prescribed as initial therapy.
      • GOLD stage C: LAMA is appropriate initial management for a patient with GOLD stage C disease, although patients with stage C disease and a history of frequent exacerbations may benefit from LAMA + LABA or LABA + ICS (inhaled corticosteroids) combination therapy for initial management.
      • GOLD stage D: Initial treatment with combined LAMA and LABA therapy is indicated for GOLD stage D, with consideration of adding of an inhaled corticosteroid (ICS) for patients with frequent exacerbations.
    • Patients with GOLD stage B, C, or D disease and high symptom burden should be referred to and encouraged to participate in pulmonary rehabilitation.

    Critical Actions

    • GOLD Criteria cannot be used to assess disease severity in patients without a measured recent FEV₁.
    • Treatment interventions initiated based on GOLD stage must always be considered in the context of an individual patient’s response, and medications should be adjusted accordingly.
    • Patient education about the risk of airways obstruction and COPD should be emphasized for former and current smokers, regardless of spirometry results or GOLD stage, and smoking cessation encouraged.
    • The GOLD Criteria do not capture or characterize former and current smokers who do not meet spirometric criteria for COPD (defined as FEV₁/FVC <0.70), as these patients are still at increased risk of respiratory symptoms (Woodruff).
    Content Contributors
    • Jeremy B. Richards, MD
    About the Creator
    Dr. Edward Petsonk
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    Content Contributors
    • Jeremy B. Richards, MD