Global Initiative for Chronic Obstructive Lung Disease

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials around the world to raise awareness of Chronic Obstructive Pulmonary Disease (COPD) and to improve prevention and treatment of this lung disease.

The GOLD initiative gives out guidelines for COPD Diagnosis, Management, and Prevention.

GOLD guidelines indicate that spirometry is of the utmost importance in diagnosing COPD.

GOLD Classification for COPD

For many years GOLD classification was based only on lung function parameters. This classic table is a measure for airflow restriction:

Grade FEV1
(% predicted)
GOLD 1: Mild COPD FEV1/FVC < 70%
FEV1 ≥ 80%
GOLD 2: Moderate COPD FEV1/FVC < 70%
FEV1: 50 - 79%
GOLD 3: Severe COPD FEV1/FVC < 70%
FEV1: 30 - 49%
GOLD 4: Very Severe COPD FEV1/FVC < 70%
FEV1 < 30%

GOLD Classification for symptom severity

In 2011 the GOLD initiative published a new classification for COPD severity. Where the older versions only took lung values in account, GOLD 2011 also takes severity of symptoms and number of exacerbations into account. Aside from the classic GOLD 1, 2, 3 and 4 stages, the new classification distinguishes also stages A, B, C and D.

The GOLD 2022 guidelines however have disconnected the symptom severity from the GOLD grade (1 to 4). According to the 2022 guidelines a patient has 2 separate classifications: GOLD 1 to 4 for airflow limitation severity and GOLD A to D for symptom burden and risk of exacerbation.

Symptom severity is assessed using the mMRC scale (modified Medical Research Council Dyspnea scale) or the CAT questionnaire (COPD Assessment Test).

The 2022 GOLD classification is as follows:

Moderate or severe
exacerbation history
>1, or 1 leading to hospital admission C D
0 or 1, not leading to hospitalization A B
mMRC 0-1
CAT <10

The GOLD classification uses risk factors (GOLD 1 to 4 and number of exacerbations) and symptom severity (mMRC or CAT scale). In case both risk factors would fall in a different category, the highest risk factor is used (eg: GOLD 1 (GOLD A or B) with 2 COPD exacerbations last year (GOLD C or D) would be GOLD C or GOLD D).

GOLD A and B are low risk, GOLD C and D are high risk patients.

GOLD A and C have few symptoms, GOLD B and D have more symptoms.

Therapy is mainly based on the symptom severity and exacerbation risk.

The official guidelines can be downloaded from the GOLD website.

Fletcher Graph

Many patients believe that once damage has been done, smoking cessation isn't necessary anymore.
The Fletcher-Peto graph clearly shows the importance to quit smoking, even if serious damage is already present.

fletcher-peto graph
Fletcher's graph clearly shows the importance of smoking cessation, even in late stage COPD