A 58-year-old smoker (40 pack-years) has COPD with post-bronchodilator FEV1/FVC 0.62 and FEV1 42% predicted. He has 3 exacerbations in the past year, including 1 hospitalisation. His resting SpO2 is 91%. Which GOLD group is he in and what maintenance therapy is recommended?
- A GOLD Group B — LABA + LAMA dual bronchodilator therapy
- B GOLD Group A — short-acting bronchodilator as needed only
- C GOLD Group E — LABA + LAMA + ICS triple therapy; consider roflumilast if FEV1 < 50% with chronic bronchitis ✓
- D GOLD Group C — ICS + LABA as preferred initial therapy
Explanation
Per GOLD 2023 guidelines, patients with ≥ 2 moderate exacerbations (or ≥ 1 hospitalisation) are classified as GOLD Group E (formerly group D), which is the highest exacerbation risk group. Initial maintenance therapy is triple inhaled therapy (LABA + LAMA + ICS). In patients with FEV1 < 50% with a chronic bronchitis phenotype and continued exacerbations despite triple therapy, the PDE4 inhibitor roflumilast can be added. GOLD Group B (low exacerbation risk, more symptoms) receives dual LABA+LAMA. SpO2 91% at rest may indicate need for long-term oxygen therapy assessment (PaO2 < 55 mmHg threshold).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.