COPD management: GOLD ABE assessment and initial inhaler therapy
What the major U.S. guidelines recommend, with a link to verify each at the source. A quick-reference summary for clinicians, not medical advice.
ABE groups by symptoms (mMRC 0-1/CAT under 10 vs mMRC 2 or more/CAT 10 or more) and exacerbations. Initial inhaler: Group A, one long-acting bronchodilator; Group B, LABA plus LAMA; Group E, LABA plus LAMA, add ICS (triple) if blood eosinophils 300 or higher. Confirm with post-bronchodilator FEV1/FVC under 0.70.
Verify at GOLD →Group A/B: zero moderate or severe exacerbations in the prior year. Group E: one or more moderate or severe exacerbations (2026 lowered this threshold from the prior 2 or more, or 1 hospitalization). On follow-up, escalate to triple therapy if eosinophils 100 or higher with further exacerbations; avoid ICS if eosinophils under 100.
Verify at GOLD →