GOLD ABE assessment (COPD)
Initial COPD group (A, B, E) to guide first pharmacological treatment — GOLD 2023+
- GOLD 2023 report
Sources last checked: 2026-10-13
GOLD ABE assessment (COPD)
Initial COPD group (A, B, E) to guide first pharmacological treatment — GOLD 2023+
Applies only after COPD is confirmed by spirometry (post-bronchodilator FEV₁/FVC < 0.7). The ABE group guides INITIAL treatment; follow-up treatment is driven by the dominant treatable trait (dyspnoea or exacerbations). Spirometric grade (GOLD 1–4) is reported separately.
Interpretation
| Group A | Few symptoms, low exacerbation risk. GOLD initial therapy: a bronchodilator. |
|---|---|
| Group B | More symptoms, low exacerbation risk. GOLD 2023 initial therapy: LABA + LAMA. |
| Group E | Exacerbation risk (regardless of symptoms). GOLD 2023 initial therapy: LABA + LAMA; GOLD 2023 lists LABA + LAMA + ICS as an option if blood eosinophils ≥ 300 cells/µL. |
What is the GOLD ABE assessment (COPD)?
The GOLD ABE tool assigns a patient with spirometry-confirmed COPD to group A, B or E using exacerbation history in the previous year and symptom burden (mMRC or CAT). It was introduced in the GOLD 2023 report, which merged the former groups C and D into a single group E ('exacerbations') because exacerbation risk, not symptoms, should drive treatment in those patients.
When to use it
- At diagnosis of COPD, to choose the initial inhaled pharmacological treatment
- When re-assessing a patient whose exacerbation history has changed
- Teaching the structure of current GOLD recommendations
When not to use it
- Before COPD is confirmed by post-bronchodilator spirometry (FEV₁/FVC < 0.7)
- For follow-up treatment adjustments — GOLD then uses the dominant treatable trait (dyspnoea or exacerbations) instead of the group
- During an acute exacerbation
Clinical pearls and limitations
- Applies only after COPD is confirmed by spirometry (post-bronchodilator FEV₁/FVC < 0.7). The ABE group guides INITIAL treatment; follow-up treatment is driven by the dominant treatable trait (dyspnoea or exacerbations). Spirometric grade (GOLD 1–4) is reported separately.
- One exacerbation leading to hospital admission is enough to place the patient in group E, regardless of symptoms.
- Group B now starts on dual long-acting bronchodilation (LABA + LAMA) rather than monotherapy.
- In group E, GOLD 2023 lists initial triple therapy with an ICS as an option when the blood eosinophil count is ≥ 300 cells/µL.
- Spirometric grade (GOLD 1–4) is reported alongside the group but does not change it.
Frequently asked questions
What happened to GOLD groups C and D?
Since the 2023 report they are merged into group E. Anyone with ≥ 2 moderate exacerbations or ≥ 1 hospitalised exacerbation in the previous year is in group E.
What counts as high symptom burden?
An mMRC grade ≥ 2 or a CAT score ≥ 10. Patients below both thresholds have low symptom burden.
What is first-line treatment in GOLD group B?
GOLD 2023 recommends a LABA + LAMA combination for group B, because dual bronchodilation outperforms monotherapy with similar side effects.
Is the ABE tool used in Europe?
Yes. GOLD is an international strategy and its executive summary was published in the European Respiratory Journal; many national guidelines align with it, though some differ in detail.
Evidence and guidelines
- Primary source: Agustí A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Eur Respir J 2023;61(4):2300239.
- GOLD — current Global Strategy reports (goldcopd.org).
- Fekete M et al. Analysis of COPD: distinguishing characteristics and management of smoking vs never smoking patients. Int J Chron Obstruct Pulmon Dis 2024;19:2671-2688 — states the ABE group criteria in text.
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