>2
RISK
GOLD
3
D
2
A
B
1
1
0
mMRC < 2
mMRC >2
CAT <10
CAT >10
Type
Charatteristic
Spirometric
classification
Exacerbation
Per year
CAT
A
B
C
D
Low risk, low symptoms
GOLD1 / GOLD2
<1
< 10
Low risk, high symptoms
GOLD1 / GOLD2
<1
> 10
High risk, low symptoms
GOLD3 / GOLD4
+2
< 10
High risk, High symptoms
GOLD3 / GOLD4
+2
> 10
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C
RISK
Exacerbation
4
>2
RISK
GOLD
3
D
2
A
B
1
1
0
mMRC < 2
mMRC >2
CAT <10
CAT >10
Type
First choice
Second choice
Alternative choice
A
SABA or SAMA prn
SABA and SAMA
LABA or LAMA
Theophylline
B
LABA or LAMA
LABA and LAMA
Theophylline
SABA and/or SAMA
C
ICS/LABA or LAMA
LABA and LAMA
ICS and LAMA
Theophylline
SABA and/or SAMA
Consider PDE4-inh*
D
ICS/LABA or LAMA
ICS/LABA and LAMA
ICS/LABA and PDE4-inh*
LAMA and PDE4-inh
Theophylline
SABA and/or SAMA
Carbocysteine
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C
RISK
Exacerbation
4
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GOLD spirometric level
GOLD 1:
GOLD 2:
GOLD 3:
GOLD 4:
Mild
Moderate
Severe
Very severe
Exacerbations
(per year)*†≠
?
0.7 - 0.9
1.1 - 1.3
1.2 – 2.0
Hospitalizations
(per year)* ≠
?
0.11 - 0.2
0.25 - 0.3
0.4 - 0.54
3-year Mortality*†
?
11%*†
15%*
24%*
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Figure 2.3: RISK IN COPD: Placebo-limb data from TORCH143*,
Uplift142† and Eclipse131≠
PLEASE TICK IN THE BOX THAT APPLIES TO YOU
(ONE BOX ONLY)
mMRC Grade 0. I only get breathless with strenuous exercise.
mMRC Grade 1. I get short of breath when hurrying on the level
or walking up a slight hill.
mMRC Grade 2. I walk slower than people of the same age on the
level because of breathlessness, or I have to stop for breath when
walking on my own pace on the level.
mMRC Grade 3. I stop for breath after walking about 100 meters or
after a few minutes on the level.
mMRC Grade 4. I am too breathless to leave the house or I am
breathless when dressing or undressing.
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Table 2.3: Modified Medical Research Council Questionnaire for Assessing the Severity of
Breathlessness