This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Chronic obstructive pulmonary disease (COPD) is assessed with the GOLD report (Global Initiative for Chronic Obstructive Lung Disease), updated every year. It separates two questions: how severe the airflow obstruction is on spirometry, and how much the disease affects the patient through breathlessness and flare-ups, which guides the first treatment.
Step 1: confirm COPD
COPD is confirmed when the ratio FEV1/FVC is below 0.70 after a bronchodilator, in a person with symptoms or exposure to risk factors such as smoking. A ratio of 0.70 or more rules out persistent obstruction.
Step 2: spirometric grade
| GOLD grade | FEV1 (% of predicted) | Severity |
|---|---|---|
| 1 | 80% or more | mild |
| 2 | 50 to 79% | moderate |
| 3 | 30 to 49% | severe |
| 4 | under 30% | very severe |
Step 3: ABE group
| Group | Flare-ups in the past year | Symptoms |
|---|---|---|
| A | 0 or 1 moderate, no hospital stay | mMRC 0 to 1 |
| B | 0 or 1 moderate, no hospital stay | mMRC 2 or more |
| E | 2 or more moderate, or 1 or more leading to a hospital stay | any |
GOLD also accepts the CAT questionnaire (10 or more counts as many symptoms); this calculator uses the mMRC breathlessness scale. Since 2023, the former groups C and D are merged into group E.
Example
A patient with a post-bronchodilator FEV1/FVC of 0.62 and an FEV1 of 58% of predicted has GOLD 2 COPD. Breathless enough to walk slower than people of the same age (mMRC 2) with one moderate flare-up last year, they are in group B.
Usual first treatment
- Group A: a bronchodilator, short or long acting.
- Group B: a long-acting beta agonist with a long-acting muscarinic antagonist (LABA + LAMA).
- Group E: LABA + LAMA; adding an inhaled corticosteroid is considered when blood eosinophils are 300 per µL or more.
Treatment is then adjusted to symptoms and flare-ups during follow-up.
Beyond medicines
Stopping smoking is the single most effective measure. Pulmonary rehabilitation, vaccinations (flu, COVID-19, pneumococcus, RSV), staying physically active and a written action plan for flare-ups improve quality of life. Long-term oxygen helps people with very low blood oxygen at rest.