The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is an organization that produces reports and guidelines on lung disease.

Chronic obstructive pulmonary disease (COPD) is the term for a group of lung diseases that can result from smoking. People with COPD can experience a wide range of symptoms due to the condition.

GOLD provides grades and categories to classify the severity and type of COPD symptoms. This information helps doctors determine the best treatment options for people with COPD.

This article discusses what GOLD is, how its categorization systems work, and how it can guide treatment.

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GOLD is an acronym for the Global Initiative for Chronic Obstructive Lung Disease. It is an international organization that works with public health workers and healthcare professionals to raise awareness around COPD.

The Centers for Disease Control and Prevention (CDC) say that COPD refers to a group of related lung diseases that cause blocked airflow on expiration and breathing-related problems.

The organization notes that at least 16 million people in the United States have a COPD diagnosis, with more likely to have the condition without being aware of it. COPD is the fourth leading cause of death in the U.S.

The National Heart, Lung, and Blood Institute (NHLBI) describes COPD as a progressive disease, which means that the condition will worsen over time. However, treatment can improve a person’s quality of life and slow the disease progression.

GOLD creates an annual “GOLD Report” for healthcare workers, officials, and any other interested parties. The 2021 GOLD Report is available for download here.

GOLD uses research findings and committees of experts to inform its reports. It aims to improve understanding of COPD, providing guidance on the latest treatment options and diagnostic criteria for the condition.

A 2012 paper by GOLD recommends that doctors use spirometry for the diagnosis of COPD. Spirometry is useful for avoiding misdiagnosis and determining the severity or stage of COPD.

When diagnosing COPD, a doctor should assess the:

  • symptoms
  • severity of airflow limitation
  • history of exacerbations
  • presence of other health conditions

An updated 2019 paper compared the differences between the 2011 and 2017 GOLD standards of COPD staging. These stages can guide healthcare professionals’ treatment decisions.

The GOLD Report breaks down the classifications and stages of COPD into two categories.

The first category consists of four COPD grades and bases the classification on forced expiratory volume (FEV). A doctor determines a person’s FEV score by testing how much air volume they can breathe out in a set number of seconds. They typically opt for FEV1 scores, which use just 1 second for this test.

The grades in this category look at the FEV1 score as a percentage of the predicted score. They are:

  • Grade 1 (mild): FEV1 equal or greater than 80%
  • Grade 2 (moderate): FEV1 between 50% and 79%
  • Grade 3 (severe): FEV1 between 30% and 49%
  • Grade 4 (very severe): FEV1 less than 30%

The GOLD Report also uses another classification system, which involves lettered groups. The letter indicates the person’s medical history and scores on other tests of symptom severity. These include COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scores, both of which show the impact of COPD on daily living.

The letter categories include:

  • A: mMRC score of 0–1, CAT score under 10, and zero or one exacerbations that did not require hospitalization.
  • B: mMRC score of 2 or more, CAT score of 10 or more, and zero or one exacerbations that did not require hospitalization.
  • C: mMRC score of 0–1, CAT score under 10, and either two or more exacerbations or one or more exacerbations that required hospitalization.
  • D: mMRC score of 2 or more, CAT score of 10 or more, and either two or more exacerbations or one or more exacerbations that required hospitalization.

People with Grade 1 and Category A COPD typically have the fewest symptoms and the best outlook.

In a 2014 study, researchers found that the lettered categories were a better predictor of quality of life and COPD costs than the numbered grades.

For example, someone with Grade 1 and Category D COPD may have a lower quality of life and higher treatment costs than someone with Grade 2 and Category A COPD.

The GOLD categories can guide treatment by outlining symptom severity and the impact of COPD on quality of life.

According to the American Lung Association, treatment approaches will vary greatly among individuals. Some common treatments for COPD include:

  • medications
  • supplemental oxygen
  • pulmonary rehabilitation
  • surgery
  • clinical trials
  • end-of-life care

According to the NHLBI, the most important step for avoiding COPD is to avoid or quit smoking. The institute also recommends avoiding irritants, such as:

  • chemical fumes
  • air pollution
  • dust
  • secondhand smoke

In those who have received a COPD diagnosis, taking medications as a doctor has prescribed them can help control the symptoms and minimize the chance of exacerbations.

A person should always talk with a doctor if they experience new or worsening COPD symptoms. The doctor can assess the person’s condition and determine the best treatment options.

People without a diagnosis should be aware of the early signs of COPD. These include some of the common symptoms of the condition, such as:

  • frequent respiratory infections
  • a chronic cough
  • wheezing
  • blue tinge to the fingernails or lips
  • excessive mucus production
  • shortness of breath during normal activities
  • fatigue

GOLD is an organization that raises awareness of the treatment, prevention, and management of COPD. It provides grades and categories to help doctors diagnose and treat people with COPD.

There may be many people with COPD who have not received a diagnosis. Anyone with signs of COPD should speak with a doctor.

Those with a diagnosis should seek medical advice if their treatment plan is proving ineffective.