Table 3. Pharmacological treatment for chronic obstructive lung disease*.

GOLD group	Symptoms more important		Exacerbations more important		Initial therapy	Follow-up therapy
	Mild to moderate symptoms	Moderate to severe symptoms				Symptoms more important	Exacerbations more important
	mMRC < 2 cat < 10	mMRC ≥ 2 CAT ≥ 10	0–1	≥ 2 or 1 severe (hospital admission)
Group A	x		x		1 Bronchodilator	LABA + LAMA	LABA + LAMA
Group B		x	x		LABA or LAMA or LABA + LAMA	LABA + LAMA	LABA + LAMA
Group E(formerly C and D)	x	x		x	LAMA or LABA + LAMA or LABA + ICS*1 LABA + LAMA + ICS*1	LABA + LAMALABA + LAMA + ICS Symptoms have another cause? Device appropriate for the patient?	LABA + LAMA + ICS*2 roflumilast*3 azithromycin*4

*In the new GOLD recommendation, GOLD groups ABE are determined on the basis of symptom and exacerbation history (e4). This classification merges the former GOLD groups C and D based on exacerbations alone to form a group designated E. The main aim of the GOLD classifications has been to provide an efficient but also practical way to assess disease progression and the treatment goals of reduced symptom burden, improved quality of life, and avoidance of exacerbations. Initial therapy and follow-up therapy are carried out based on GOLD group or the leading problem in the individual case (in terms of symptoms or exacerbations). The fact that treatment is based primarily on symptom and exacerbation history underscores the central importance of history-taking in patient care. The table is based on the recommendations of the German National Clinical Guideline for COPD (6) and the international GOLD recommendations of the current GOLD Report 2023 (e4). The current GOLD recommendations for initial therapy are shown in bold; according to these, initial treatment in severely symptomatic patients should be with a LABA/LAMA combination, and initial therapy in patients with exacerbations and a peripheral blood eosinophil count > 300 cells/µL should be with a LABA/LAMA/ICS combination.

CAT, COPD Assessment Test; ICS, inhaled steroid; LABA, long-acting ß-agonist; LAMA, anticholinergic; mMRC, modified Medical Research Council Dyspnoea Scale *¹ If peripheral blood eosinophilia ≥ 300 cells/µL, *² If peripheral blood eosinophilia ≥ 100 cells/µL, *³ If peripheral blood eosinophilia < 100 cells/µL, FEV₁ < 50% of reference value, and chronic bronchitis, *⁴ In ex-smokers, off-label use – not currently recommended in German National Clinical Guideline for COPD but included in the GOLD recommendations.