Global Strategy for Diagnosis, Management and Prevention of COPD

Combined Assessment of COPD

(GOLD Classification of Airflow Limitation)

4
>2
(C) (D)

(Exacerbation history)
3

Risk
Risk

2
1
(A) (B)
1 0

mMRC 0-1 mMRC > 2

CAT < 10 CAT > 10
Symptoms
(mMRC or CAT score))
Global Strategy for Diagnosis, Management and Prevention of COPD

Combined Assessment of COPD

Assess symptoms first

If mMRC 0-1 or CAT < 10:

(C) (D) Less Symptoms (A or C)

If mMRC > 2 or CAT > 10:

More Symptoms (B or D)
(A) (B)
mMRC 0-1 mMRC > 2
CAT < 10 CAT > 10
Symptoms
(mMRC or CAT score))
 Global Strategy for Diagnosis, Management and Prevention of COPD

Combined Assessment of COPD

Assess risk of exacerbations next
(GOLD Classification of Airflow Limitation)

4
If GOLD 1 or 2 and only

(Exacerbation history)
3
(C) (D) >2 0 or 1 exacerbations per year:
Risk

Risk
Low Risk (A or B)
2 1 If GOLD 3 or 4 or two or
(A) (B) more exacerbations per year:
1 0 High Risk (C or D)
mMRC 0-1 mMRC > 2
CAT < 10 CAT > 10
Symptoms
(mMRC or CAT score))
 Global Strategy for Diagnosis, Management and Prevention of COPD

Combined Assessment of COPD

Use combined assessment
(GOLD Classification of Airflow Limitation)

Patient is now in one of

4 four categories:

(Exacerbation history)
3
(C) (D) >2
A: Les symptoms, low risk
Risk

Risk
B: More symtoms, low risk
2 1
(A) (B) C: Less symptoms, high risk
1 0
D: More Symtoms, high risk
mMRC 0-1 mMRC > 2
CAT < 10 CAT > 10
Symptoms
(mMRC or CAT score))
Global Strategy for Diagnosis, Management and Prevention of COPD

Combined Assessment of COPD

(GOLD Classification of Airflow Limitation)

4
>2
(C) (D)

(Exacerbation history)
3

Risk
Risk

2
1
(A) (B)
1 0

mMRC 0-1 mMRC > 2

CAT < 10 CAT > 10
Symptoms
(mMRC or CAT score))
 Global Strategy for Diagnosis, Management and Prevention
of COPD

Combined Assessment of
COPD

When assessing risk, choose the highest risk

according to GOLD grade or exacerbation history

Patien Characteristic Spirometric Exacerbations mMRC CAT

t Classification per year
Low Risk
A GOLD 1-2 ≤1 0-1 < 10
Less Symptoms
Low Risk
B GOLD 1-2 ≤1 >2 ≥ 10
More Symptoms
High Risk
C GOLD 3-4 >2 0-1 < 10
Less Symptoms
High Risk ≥ 10
D GOLD 3-4 >2 >2
More Symptoms
Patient First choice Second choice Alternative Choices

LAMA
SAMA prn or
A or LABA Theophylline
SABA prn or
SABA and SAMA
LAMA
SABA and/or SAMA
B or LAMA and LABA
Theophylline
LABA
ICS + LABA
PDE4-inh.
or
C LAMA and LABA SABA and/or SAMA
LAMA
Theophylline

ICS and LAMA or

ICS + LABA
ICS + LABA and LAMA or Carbocysteine
or
D ICS+LABA and PDE4-inh. or SABA and/or SAMA
LAMA
LAMA and LABA or Theophylline
LAMA and PDE4-inh.
 C D
GOLD 4

Exacerbations per year

ICS + LABA ICS + LABA
>2
or or
LAMA LAMA
GOLD 3

A B
GOLD 2
SAMA prn LABA 1
or or
GOLD 1 SABA prn LAMA
0

mMRC 0-1 mMRC > 2

CAT < 10 CAT > 10
 C D
GOLD 4

Exacerbations per year

LAMA and LABA ICS and LAMA or
ICS + LABA and LAMA or >2
ICS + LABA and PDE4-inh or
GOLD 3 LAMA and LABA or
LAMA and PDE4-inh.

A B
GOLD 2
LAMA or LAMA and LABA 1
LABA or
GOLD 1 SABA and SAMA
0

mMRC 0-1 mMRC > 2

CAT < 10 CAT > 10
 C D
GOLD 4 PDE4-inh. Carbocysteine

Exacerbations per year

SABA and/or SAMA SABA and/or SAMA >2
Theophylline Theophylline
GOLD 3

GOLD 2 A B
SABA and/or SAMA 1
Theophylline Theophylline
GOLD 1
0

mMRC 0-1 mMRC > 2

CAT < 10 CAT > 10