GOLD ABE
COPD Group Assessment (GOLD 2023)
A = mild · B = symptomatic · E = exacerbator. Groups drive pharmacotherapy.
Clinicians lean on this acronym when an established COPD patient needs a regimen — and the regimen depends on which GOLD group they fall into. GOLD 2023 collapsed the old ABCD into ABE: Group A is mild symptoms (mMRC 0-1, CAT under 10) with 0-1 exacerbations; Group B is symptomatic (mMRC 2+, CAT 10+) with 0-1 exacerbations; Group E is anyone with 2+ moderate exacerbations or 1 leading to hospitalization. Group A starts a bronchodilator; B steps to LABA/LAMA; E gets LABA/LAMA with ICS added if eosinophils 300+ or repeat exacerbations. AANP boards tests the group and the inhaler that pairs with it.
- ALow symptoms, low exacerbation riskmMRC 0-1 or CAT <10, AND 0-1 exacerbations per year (no hospitalization). First-line: a bronchodilator (SABA/SAMA PRN or LAMA or LABA).
- BHigh symptoms, low exacerbation riskmMRC ≥2 or CAT ≥10, AND 0-1 exacerbations per year (no hospitalization). First-line: LABA + LAMA combination.
- EExacerbator (regardless of symptoms)≥2 moderate exacerbations OR ≥1 hospitalization in the past year. First-line: LABA + LAMA; add ICS if blood eosinophils ≥300 or history of asthma.
Clinical Context
GOLD 2023 replaced the older ABCD framework with ABE, collapsing C and D into a single "exacerbator" group because exacerbation history is the strongest driver of outcomes and pharmacotherapy. Spirometry (FEV1/FVC <0.7 post-bronchodilator) confirms the diagnosis; FEV1 % predicted drives GOLD 1-4 staging (mild/moderate/severe/very severe) which is SEPARATE from the ABE group.
Key AANP pearls: ICS monotherapy is NOT first-line in COPD (differs from asthma); add ICS only for E group with eosinophilic phenotype or asthma overlap. Non-pharm is always step 1 — smoking cessation, pneumococcal + annual flu + RSV + COVID vaccines, pulmonary rehab for mMRC ≥2. Oxygen therapy only when resting SaO2 ≤88% or PaO2 ≤55 mmHg.
Related Mnemonics
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Sources
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