GOLD Guidelines for COPD

Diagnosis & Assessment

• Airflow obstruction: post‑bronchodilator FEV1/FVC < 0.70 confirms COPD.
• Assess symptoms (CAT or mMRC), exacerbation history, blood eosinophils, and comorbidities.
• Use groups A, B, E (E = exacerbation‑prone) to guide initial therapy.

Initial Pharmacologic Therapy

• Bronchodilators first: LABA or LAMA; consider dual LABA/LAMA for higher symptom burden.
• Inhaled corticosteroids (ICS): reserve for patients with frequent exacerbations and higher eosinophils; avoid routine LABA+ICS if not indicated.

Follow‑Up & Exacerbation Prevention

• Step up to dual bronchodilator (LABA/LAMA) or add ICS based on symptoms, exacerbations, and eosinophils.
• New options in algorithms: ensifentrine (PDE3/4 inhibitor) and dupilumab (IL‑4/13 blocker) for selected frequent exacerbators.
• Non‑pharmacologic: smoking cessation, vaccines, pulmonary rehab/activity, nutrition, education, inhaler technique checks.

Acute Exacerbations (AECOPD)

• Short‑acting bronchodilators, systemic steroids, antibiotics when indicated; oxygen/NIV as needed.
• Always consider mimics/overlaps (pneumonia, heart failure, PE).

Comorbidities

• Screen and treat common comorbidities (CVD, lung cancer risk, osteoporosis, diabetes, anxiety/depression) to improve outcomes.

GOLD COPD Severity Staging

• Normal spirometry: FEV₁/FVC ≥ 0.70 and FEV₁ ≥ 80% predicted
• GOLD 1 (Mild): FEV₁/FVC < 0.70 and FEV₁ ≥ 80% predicted
• GOLD 2 (Moderate): FEV₁ 50–79% predicted (with FEV₁/FVC < 0.70)
• GOLD 3 (Severe): FEV₁ 30–49% predicted (with FEV₁/FVC < 0.70)
• GOLD 4 (Very Severe): FEV₁ < 30% predicted (with FEV₁/FVC < 0.70)

Severity grading (1–4) applies only when post‑bronchodilator FEV₁/FVC < 0.70 is present. Normal requires preserved ratio. Combine severity with symptom burden (CAT/mMRC) and exacerbation risk to classify patients into Groups A, B, or E.