[COPD Classification GOLD I-IV vs. GOLD A-D in Real Life: Comparing Impact on Application, Advantages and...

COPD patients under shared treatment of general practitioners and pulmonologists were grouped in GOLD classification I-IV and A-D, respectively to find out whether the new A-D classification showed advantages concerning therapy decisions. As a result of CAT separation at 10 points (GOLD A-D rule) group C with higher risk and low symptoms was very small. It is described how CAT threshold values of 15 and 20 points would affect the size of the groups A-D in pulmonary practice. The new A-D classification showed better signals for exacerbations. Regardless of the classification I-IV or A-D respectively patients received a considerable amount of overtreatment (low degrees of severity) or undertreatment (higher degrees of severity). Only the application of prednisolone and of roflumilast, respectively, showed a noticeable relation to increased exacerbations in system A-D. A variety of reasons might cause that obviously the principles of both classifications are followed poorly. Higher attention for exacerbations may be considered as a progress resulting from the new a-d classification. Possible abrupt short term intraindividual changes of severity, inadequate to the global course of disease, are a possible disadvantage of the new A-D classification.