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    Patent Pending

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

    Assesses different stages of COPD and provides treatment recommendations.

    INSTRUCTIONS

    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
    Pearls/Pitfalls
    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
    ≥80
    50–79
    30–49
    <30

    Result:

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    Next Steps
    Evidence
    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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    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Jeremy B. Richards, MD
    About the Creator
    Dr. Edward Petsonk
    Are you Dr. Edward Petsonk?
    Content Contributors
    • Jeremy B. Richards, MD