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.
Advice
- Patients meeting spirometric criteria for airway 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 B or E, or patients with difficult-to-control symptoms or frequent COPD exacerbations.
Management
- 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: Both a long-acting bronchodilator (LABA) and long-acting methacholine antagonist (LAMA) should be prescribed as initial therapy. If adherence is a concern, inhaler monotherapy may be considered.
- GOLD stage E: Initial treatment includes LAMA and LABA. An inhaled corticosteroid (ICS) should be considered for patients with elevated blood eosinophils (≥300).
- Patients with GOLD stage B or E 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).