Gold classification

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) first published the GOLD classification in 2001. In the following years, several additions and revisions were made (Arand 2017).

The GOLD classification is used to assess the severity of respiratory obstruction in COPD (Arand 2017) and emphysema (Hemgesberg 2014). It is also an important prognostic factor (Kasper 2015) and provides a treatment logarithm (Arand 2017).

In the GOLD classification for COPD, two additional parameters have been considered since the last revision in 2017:

- 1. symptomatology

Assessed by the CAT- score (COPD Assessment Test for self-assessment) and the mMRC (Modified Medical Research Council questionnaire) to assess the severity of dyspnea (Wolff 2022).

- 2. exacerbations and hospitalizations per year (Herold 2022).

This results in 4 different patient groups according to GOLD depending on symptomatology and exacerbations (Braun 2022) from A - D:

- Patient group A:

- low risk, little symptomatology

- ≤ 1 exacerbations / year

- mMRC 0 - 1

- CAT < 10 (Herold 2022)

- Severity I - II (Brown 2022).

- Patient group B:

- Low risk, more severe symptomatology

- ≤ 1 exacerbations / year

- mMRC ≥ 2

- CAT ≥ 10 (Herold 2022)

- Severity I - II (Brown 2022).

- Patient group C:

- High risk, low symptomatology

- ≥ 2 exacerbations / year

- mMRC 0 - 1

- CAT < 10 (Herold 2022)

- Severity III - IV (Braun 2022)

- Patient group D:

- High risk, more severe symptomatology

- ≥ 2 exacerbations / year

- mMRC ≥ 2

- CAT ≥ 10 (Herold 2022)

- Severity III - IV (Brown 2022).

One differentiates between 4 different GOLD stages in COPD. These are based on the respective severity of airflow limitation:

- GOLD 1

Mild impairment of airflow limitation.

FEV1 % of target after bronchodilation ≥ 80% (Herold 2022).

- GOLD 2

Moderate influence of airflow obstruction.

FEV1 % of target after bronchodilation between 50 - 79 % (Herold 2022)

- GOLD 3

Severe impact of airflow obstruction

FEV1 % of target after bronchodilation between 30 - 49 % (Herold 2022)

- GOLD 4

Very severe impairment of airflow obstruction

FEV1 % of target after bronchodilation < 30 % (Herold 2022)

Classification of GOLD classes in emphysema:

- Gold 1

Mild emphysema

- Gold 2

Moderate grade emphysema

- Gold 3

Severe emphysema

- Gold 4

High-grade emphysema (Hemgesberg 2014)

For first-line therapy, the GOLD committee gives clear preferences:

- Group A

Bronchodilators such as beta-2 mimetics, theophylline, tiotropium/ ipratropium bromide are recommended here (Arand 2017).

- Group B.

A long-acting bronchodilator such as an anticholinergic(LAMA) or a beta2- antagonist(LABA) is recommended (Arand 2017).

- Group C.

In this group, treatment with LAMA is recommended at the beginning of therapy. However, if further exacerbations occur under this, a LAMA / LABA combination is recommended (Arand 2017).

- Group D

In group D, direct initiation with LAMA / LABA is recommended. Since pneumonia occurs frequently in this group, the combination of LABA and ICS (inhaled corticosteroids) is not considered favorable (Arand 2017).

There are also critical voices regarding the GOLD classification. Köhler et al. (2015), for example, considers the classification of the severity of COPD according to the GOLD classification at that time to be poor, since class II has more shortness of breath but is assigned to a milder severity and thus has a higher mortality than class III.

1. Arand M (2017) Chronic obstructive pulmonary disease (COPD): Classification changed. Dtsch Arztebl. 114 (9) 18 - 20.
2. Braun J, Müller- Wieland D (2022) Basic textbook of internal medicine. Elsevier Urban und Fischer Verlag Germany 410
3. Hemgesberg H (2014) Lung diseases on the rise: "When the lungs go on strike" - The fatal trio: emphysema - COPD - asthma. German Lung Day. EPUB ISBN/EAN: 9783847607328. chapter pulmonary emphysema and COPD.
4. Herold G et al (2022) Internal Medicine. Herold Publishers 350
5. Kasper D L, Fauci A S, Hauser S L, Longo D L, Jameson J L, Loscalzo J et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 1704
6. Köhler D, Schönhofer B, Voshaar T (2015) Pneumology: a guide to rational action in clinic and practice. Georg Thieme Verlag Stuttgart 104
7. Wolff Weihrauch T R (2022) Internistische Therapie 2022 / 2023. Elsevier Urban und Fischer Verlag Germany 537.