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PubMed This is a summary of 4 peer-reviewed journal articles Updated

Why Can COPD Be GOLD Grade 2 and Still Be Group E?

At a Glance

A person can have GOLD Grade 2 COPD and still be in Group E because the labels measure different things: Grade 2 reflects airflow limitation on a breathing test, while Group E reflects recent moderate or severe flare-ups.

It is entirely possible to be classified as both GOLD Grade 2 and Group E because these two labels measure completely different parts of your chronic obstructive pulmonary disease (COPD). Your “Grade” is a number that measures your lung function on a breathing test, while your “Group” is a letter evaluating your daily symptoms and recent history of COPD flare-ups [1]. Having both labels is expected, not a contradiction.

By separating your lung function from your daily experience, your care team gets two distinct pieces of information to help guide your treatment plan [2].

Quick Comparison

Label What it Measures How it is Calculated What it Does Not Tell You
Grade (1–4) Airflow limitation: How open your airways are. A breathing test (spirometry) measuring your FEV1 score. It does not predict your daily symptoms or your risk of future flare-ups.
Group (A, B, or E) Exacerbation risk and symptoms: How often you have severe flare-ups and how you feel daily. Counting your moderate and severe flare-ups over the past 12 months, and checking symptom scores. It does not measure your physical lung capacity or airway obstruction.

What Does GOLD Grade 2 Mean?

To diagnose COPD, doctors first look at a ratio on your spirometry breathing test to confirm persistent airflow obstruction. Once diagnosed, your GOLD Grade (1–4) describes the severity of that airflow limitation [2].

Specifically, the grade is based on your FEV1 (forced expiratory volume in one second), which is the amount of air you can forcefully exhale in one second after taking a bronchodilator (an inhaler medicine that opens the airways) [1].

A classification of GOLD Grade 2 means your FEV1 is between 50% and less than 80% of what would be predicted for someone of your age, height, and sex [1]. While this is medically termed “moderate” airflow limitation, it is important to know that a “moderate” grade does not mean your overall illness or symptoms are moderate. Someone with Grade 2 can still have major symptoms or frequent flare-ups [2].

What Does Group E Mean?

Your Group (A, B, or E) is an evaluation of how COPD affects your day-to-day life and your recent history of exacerbations (flare-ups) [2]. It does not factor in your FEV1 score [1].

Being in Group E (the “E” stands for Exacerbations) means you have a high risk of flare-ups. You are placed in Group E if, over the previous 12 months, you have had:

  • Two or more moderate exacerbations (outpatient flare-ups treated with systemic steroids and/or antibiotics)
  • Or one or more severe exacerbations (flare-ups severe enough to require hospital admission)

You are placed in Group E based only on this history of exacerbations, regardless of your daily symptom score [3].

Your doctor will still evaluate your daily symptoms using questionnaires like the COPD Assessment Test (CAT), which measures the broader health impact of COPD, or the modified Medical Research Council (mMRC) scale, which focuses mainly on breathlessness [3]. However, these symptom scores are primarily used to distinguish between Groups A and B for patients who do not have a high number of exacerbations [3].

Can These Labels Change Over Time?

Yes, both labels can change independently of each other [2].

Your ABE group is highly dependent on your past year. Exacerbation frequency can fluctuate significantly over time, and many patients do not remain frequent exacerbators forever [4]. If you go a full 12 months without having qualifying exacerbations, your clinician may move you out of Group E and into Group A or B [4].

However, moving to a new group does not mean your COPD is cured, nor does it automatically mean you should stop or reduce your inhalers. Treatment decisions rely on more than just these labels; your doctor will also consider your current symptoms, blood eosinophil levels (a type of white blood cell), other medical conditions, and how well you use your inhalers [2].

Meanwhile, your spirometric grade (Grade 2) might remain stable even if your group changes [2]. Because they measure different dimensions of the disease, neither label alone provides an exact prognosis (a prediction of what may happen over time) [1]. Together, they simply help your care team understand important aspects of your COPD to guide your care.

Common questions in this guide

Why can I have GOLD Grade 2 COPD and still be in Group E?
GOLD Grade 2 describes airflow limitation measured by the FEV1 on a breathing test. Group E describes a high recent risk of COPD flare-ups, so the two labels measure different parts of the disease and can occur together.
What does GOLD Grade 2 mean on a COPD breathing test?
GOLD Grade 2 means your FEV1 is 50% to less than 80% of the predicted value after a bronchodilator. It describes moderate airflow limitation, but it does not by itself show how severe your symptoms are or how often you may have flare-ups.
What qualifies someone for Group E COPD?
Group E generally means that, in the previous 12 months, a person had at least two moderate flare-ups treated outside the hospital or at least one severe flare-up requiring hospital admission. This classification is based on exacerbation history, regardless of the daily symptom score.
Does Group E mean that my lung function is severely reduced?
No. Group E indicates a high recent risk of COPD flare-ups, not a specific level of lung function. A person can have GOLD Grade 2 airflow limitation and still meet the criteria for Group E.
Can my COPD grade or group change over time?
Yes, the grade and group can change independently. Your group may change if your flare-up history changes, while your spirometry grade may remain stable; treatment changes should be discussed with your clinician rather than made on your own.
Do CAT or mMRC symptom scores determine whether I am in Group E?
Group E is determined by qualifying moderate or severe flare-ups in the previous year. CAT and mMRC questionnaires still help track symptoms and are especially useful for distinguishing Groups A and B when a person does not have a high exacerbation risk.

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References

References (4)
  1. 1

    Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary.

    Vogelmeier CF, Criner GJ, Martinez FJ, et al.

    American journal of respiratory and critical care medicine 2017; (195(5)):557-582 doi:10.1164/rccm.201701-0218PP.

    PMID: 28128970
  2. 2

    Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary.

    Vogelmeier CF, Criner GJ, Martinez FJ, et al.

    The European respiratory journal 2017; (49(3)) doi:10.1183/13993003.00214-2017.

    PMID: 28182564
  3. 3

    Assessing Symptom Burden.

    Vogelmeier CF, Alter P

    Clinics in chest medicine 2020; (41(3)):367-373 doi:10.1016/j.ccm.2020.06.005.

    PMID: 32800191
  4. 4

    Stability of the frequent COPD exacerbator in the general population: A Danish nationwide register-based study.

    Reilev M, Lykkegaard J, Halling A, et al.

    NPJ primary care respiratory medicine 2017; (27(1)):25 doi:10.1038/s41533-017-0029-7.

    PMID: 28416794

This page explains what GOLD Grade 2 and Group E mean in COPD for informational purposes only and does not constitute medical advice. Ask your clinician to interpret your spirometry, flare-up history, symptoms, and treatment plan.