Spirometry, the traditional method for grading disease severity in chronic obstructive pulmonary disease (COPD), has limitations as FEV1 correlates poorly with clinically relevant outcomes such as health-related quality of life, breathlessness, and exercise capacity (1). Since 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has recommended that decisions regarding COPD management and treatment should consider future risk of exacerbations (determined by exacerbation history or airflow obstruction) and disease impact on symptoms (using either the modified Medical Research Council dyspnea score [mMRC] or the COPD Assessment Test [CAT]). Hence, patients can be classified into four GOLD categories comprising A: low risk, fewer symptoms; B: low risk, more symptoms; C: high risk, fewer symptoms; and D: high risk, more symptoms. GOLD classifies a higher level of symptoms using the following cut points: mMRC ≥ 2 or a CAT score ≥ 10, with a preference for the CAT as it gives a more comprehensive assessment of the symptomatic impact of the disease.
Publication information
Kon SS, Canavan JL, Nolan CM, Jones SE, Clark AL, Polkey MI, Man WD. The Clinical COPD Questionnaire (CCQ): Cut-point for GOLD 2013 classification. Am J Respir Crit Care Med. 2014 Jan 15;189(2):227-8