What is Chronic Obstructive Pulmonary Disease (COPD) Global Initiative for Chronic Obstructive Lung Disease (GOLD) group E?

COPD GOLD Group E Does Not Exist

COPD GOLD Group E is not a valid classification—the current GOLD system uses only groups A, B, C, and D based on symptom burden and exacerbation history. 1, 2

Understanding the Current GOLD ABCD Classification

The GOLD 2017 guidelines fundamentally restructured COPD assessment by separating spirometric severity from the ABCD grouping system. 1 This represents a major departure from earlier versions where lung function influenced group assignment. 2

The Four Valid GOLD Groups

The ABCD groups are now derived exclusively from two parameters: 1, 2

• Symptom burden (measured by CAT ≥10 or mMRC ≥2 = "high symptoms") 2
• Exacerbation history (≥2 moderate exacerbations OR ≥1 hospitalization = "high risk") 2

This creates exactly four groups: 2

• Group A: Low symptoms + Low exacerbation risk
• Group B: High symptoms + Low exacerbation risk
• Group C: Low symptoms + High exacerbation risk
• Group D: High symptoms + High exacerbation risk

Why Spirometry Is Separate

Spirometric severity (GOLD 1–4) does not reliably predict exacerbations or mortality within the same ABCD group, which is why GOLD separated lung function grading from the treatment-guiding ABCD assessment. 2 A patient can have GOLD 4 (very severe airflow limitation, FEV₁ <30% predicted) but still be classified as Group A or B if they have infrequent exacerbations. 2

Common Pitfall: Confusion with Older GOLD Versions

Prior to 2017, GOLD used a combined assessment that incorporated spirometry into the ABCD groups, creating more categories and complexity. 1, 3 The 2017 revision deliberately simplified this by making ABCD groups purely symptom- and exacerbation-based. 1 Some clinicians may mistakenly reference outdated classification schemes that no longer apply.

The Four-Domain Assessment Still Required

Although ABCD grouping uses only symptoms and exacerbations, comprehensive COPD assessment still mandates evaluation of all four domains: 2

1. Spirometric severity (GOLD 1–4)
2. Current symptom burden
3. Exacerbation history and future risk
4. Comorbidities

Comorbidities must be identified and treated independently because they significantly influence mortality and hospitalization regardless of COPD severity. 2