Traditionally, the severity of Chronic Obstructive Pulmonary Disease (COPD) exacerbations was retrospectively classified based on treatment settings: mild for ambulatory patients needing minimal adjustments, moderate if antibiotics or systemic steroids were required, and severe upon hospitalization. This classification, widely used in clinical trials and for categorizing stable patients (groups A, B, E) to guide initial pharmacological treatment, as per GOLD 2023 guidelines, has limitations in real-time clinical decision-making during exacerbations.
Recognizing this gap, GOLD 2024 continues to advocate for the Rome proposal, introduced in GOLD 2023, for defining and assessing COPD exacerbation severity at the point of care. This approach utilizes physiological biomarkers, independent of treatment type or location. GOLD 2024 aims to refine the application of the Rome classification in guiding acute exacerbation management, addressing crucial aspects:
Firstly, it emphasizes the distinction between physiological exacerbation classification (Rome proposal) and the care setting (outpatient, inpatient). While clinical severity influences the care site, healthcare system structures, resource availability, and patient-specific factors (e.g., social support, comorbidities) also play significant roles. GOLD 2024 acknowledges studies validating the Rome proposal’s prognostic value for mortality. Intriguingly, these studies also revealed that a considerable portion of hospitalized patients were classified as having mild exacerbations according to the Rome criteria. This highlights that hospitalization decisions are influenced by factors beyond physiological severity alone.
Secondly, for classifying stable COPD patients into groups A, B, or E to guide initial pharmacological interventions, GOLD 2024 maintains the reliance on patient recall of prior exacerbations. These past episodes are still categorized as moderate or severe based on the treatment setting and type received. This historical perspective remains essential for long-term management strategies in stable COPD.
In essence, GOLD 2024 refines the application of the Rome criteria for real-time COPD exacerbation assessment, distinguishing it from care setting decisions and reinforcing the importance of past exacerbation history in managing stable COPD. This nuanced approach ensures a more clinically relevant and patient-centered strategy in COPD management.
