The Common Question

If you have COPD, you’ve probably been prescribed one or more inhalers. Maybe you were started on one inhaler years ago, and over time, more got added. Or maybe you’re newly diagnosed and trying to figure out if what you’ve been given makes sense.

Here’s a question you should be able to answer: What’s your GOLD group?

If you don’t know, you’re not alone. But you should know, because your GOLD group determines exactly which inhalers you need—and whether you’re on the right treatment plan.

The Simple Answer

COPD management used to feel complicated, with multiple categories and confusing classifications. The 2025 GOLD guidelines simplified everything. Now there are only three groups: A, B, and E.

Your GOLD group is determined by asking two straightforward questions:

Question 1: In the past year, have you been hospitalized for COPD, or have you had two or more COPD flare-ups (exacerbations)?

If yes, you’re GOLD group E—the high-risk group.

If no, move to question 2.

Question 2: How bad are your symptoms?

This is measured with simple questionnaires. There are two common ones:

• The mMRC (Modified Medical Research Council) scale asks about breathlessness. A score of 2 or higher means significant symptoms.
• The CAT (COPD Assessment Test) asks about cough, mucus, chest tightness, breathlessness, activity limitations, confidence, sleep, and energy. A score of 10 or higher means significant symptoms.

If your symptoms are well-controlled (mMRC less than 2, or CAT less than 10), you’re GOLD group A.

If your symptoms are not well-controlled (mMRC 2 or higher, or CAT 10 or higher), you’re GOLD group B.

That’s it. Three groups. Two questions.

Why It Matters

Your GOLD Group Determines Your Treatment

Once you know your group, the treatment plan is straightforward:

GOLD Group A: One inhaler—either a LABA (long-acting beta-agonist) or a LAMA (long-acting muscarinic antagonist). Your choice.

GOLD Group B: Two medications—a LABA and a LAMA, usually combined in one inhaler.

GOLD Group E: Two medications—a LABA and a LAMA—plus maybe an inhaled corticosteroid (ICS), depending on one specific blood test.

The simplicity is the point. COPD management isn’t about throwing multiple inhalers at the problem and hoping something works. It’s about matching your treatment intensity to your actual risk and symptoms.

Understanding the Medications

Let’s break down what these medications actually do:

LABAs (long-acting beta-agonists) relax the muscles around your airways, keeping them open for 12-24 hours. They make breathing easier.

LAMAs (long-acting muscarinic antagonists) also relax airway muscles, but through a different mechanism. They reduce mucus production and help keep airways open.

Using both together works better than using just one, because they tackle the problem from two different angles.

Inhaled corticosteroids (ICS) reduce inflammation in the lungs. In COPD, they don’t work for everyone—and they come with a risk of pneumonia. So they’re only used in specific situations.

The Eosinophil Test: Who Needs an Inhaled Corticosteroid?

If you’re GOLD group E, there’s one more piece of information your doctor needs: your blood eosinophil count.

Eosinophils are a type of white blood cell. When eosinophil levels are elevated in COPD patients, it suggests that adding an inhaled corticosteroid might help prevent future flare-ups.

Here’s how the decision is made:

Eosinophils less than 100: Don’t add an inhaled corticosteroid. The risk of pneumonia outweighs any potential benefit. Treat like GOLD group B—LABA and LAMA only.

Eosinophils 300 or higher: Definitely add an inhaled corticosteroid. The benefit is clear. This is triple therapy—LABA, LAMA, and ICS, usually in one inhaler.

Eosinophils between 100 and 300: This is the gray zone. It involves a conversation between you and your doctor. The decision depends on your history, your preferences, and whether you’ve had repeated hospitalizations despite being on dual therapy.

Think of the eosinophil count as a simple blood test that tells your doctor whether your lungs are likely to respond to anti-inflammatory medication. It’s not a perfect predictor, but it’s the best tool we have.

The Precina Takeaway

At Precina Health, we see a pattern: people on medication regimens they don’t fully understand, prescribed years ago, with no clear explanation of why they’re taking what they’re taking.

COPD management doesn’t have to be that way. The GOLD group system is designed to be simple and transparent. You should be able to answer three questions about your own care:

1. What’s my GOLD group?
2. Am I on the right inhalers for that group?
3. If I’m group E, have we taken  my eosinophil count, and does it support using an inhaled corticosteroid?

If you can’t answer these questions, that’s a problem—not with you, but with how your care has been explained.

Here’s the other thing: combining medications into one inhaler is always better when it’s an option. If you need a LABA and a LAMA, you should be using a combination inhaler that delivers both. If you’re group E and need all three medications, there are triple-combination inhalers available.

Using one inhaler instead of two or three isn’t just about convenience. It’s about making your care plan something you can actually sustain. Fewer devices mean fewer chances for confusion, fewer things to refill, and a better chance that you’ll use your medications consistently.

COPD is a chronic disease. The treatment plan needs to be simple enough to live with for years.

 Next  Step

At your next appointment, ask your doctor these three questions:

1. “What’s my GOLD group—A, B, or E?”
2. “Am I on the right inhalers for that group?”
3. “If I’m group E, what’s my eosinophil count, and does it support using an inhaled corticosteroid?”

Then, ask one more: “Can my medications be combined into a single inhaler?”

If you’re on multiple inhalers and there’s a combination option available, ask to switch. Life with COPD is hard enough without juggling multiple devices.

You deserve a treatment plan that makes sense, that you understand, and that’s built for the long haul. Knowing your GOLD group is the first step.