Clinical meaning
The GOLD 2024 framework integrates spirometric severity, symptom burden, and exacerbation risk into a comprehensive assessment. Spirometric classification uses post-bronchodilator FEV1 % predicted: GOLD 1 (>= 80%), GOLD 2 (50-79%), GOLD 3 (30-49%), GOLD 4 (< 30%). The ABE assessment tool (replacing ABCD) uses mMRC dyspnea scale (0-4) or CAT score (0-40) for symptoms, and exacerbation history for risk stratification. Group A: low symptoms (mMRC 0-1, CAT < 10) and low exacerbation risk (0-1 moderate, no hospitalized). Group B: high symptoms (mMRC >= 2, CAT >= 10) and low exacerbation risk. Group E (Exacerbation): any exacerbation history >= 2 moderate or >= 1 hospitalized, regardless of symptom level. Initial pharmacotherapy follows: A = bronchodilator, B = LAMA (preferred) or LAMA+LABA, E = LAMA+LABA (+/- ICS based on eosinophils).
Diagnosis & workup
Diagnostics & workup: - Post-bronchodilator spirometry: FEV1/FVC < 0.70 with FEV1 % predicted for GOLD staging - mMRC dyspnea scale assessment (0-4) at each visit - CAT questionnaire for comprehensive symptom assessment - Exacerbation history documentation (number, severity, hospitalizations in past 12 months) - Blood eosinophil count for pharmacotherapy guidance - BODE index (BMI, Obstruction, Dyspnea, Exercise) for prognostication