A 48-year-old man with COPD has FEV1/FVC 0.58, post-BD FEV1 42% predicted, 3 exacerbations in the past year (one requiring hospitalization), and mMRC dyspnea score 3. According to GOLD 2023, what is his GOLD group and preferred initial pharmacotherapy?
- A GOLD group B — LABA + LAMA dual bronchodilator
- B GOLD group D — LABA alone
- C GOLD group E — LABA + LAMA + ICS triple therapy (or LABA+LAMA if blood eosinophils <100/µL) ✓
- D GOLD group C — ICS + LABA
Correct answer: C. GOLD group E — LABA + LAMA + ICS triple therapy (or LABA+LAMA if blood eosinophils <100/µL)
Explanation
GOLD 2023 simplified the ABCD classification to ABE. Group E (exacerbation-prone) is defined by ≥2 moderate exacerbations or ≥1 hospitalization per year. This patient has 3 exacerbations (1 hospitalization), placing him in Group E. GOLD 2023 recommends LABA+LAMA as preferred initial therapy for Group E; ICS is added (triple therapy) if blood eosinophils ≥300/µL or ≥1 hospitalization despite dual bronchodilation. Blood eosinophils guide ICS use, which was not specified here, making LABA+LAMA the core recommendation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.