GOLD classification pitfalls: beyond mMRC and CAT?

<bold>Introduction:</bold> According to the GOLD 2024 Report, the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) are useful tools for initial COPD assessment. However, in some patients these questionnaires are discordant, suggesting a different level of symptoms and burden of disease. <bold>Aims and objectives:</bold> To identify main differences in patients with discordant CAT and mMRC (GOLD_D) compared with those with concordant questionnaires. <bold>Methods:</bold> We enrolled 222 consecutive patients with a diagnosed COPD and with recorded CAT and mMRC questionnaires, looking for main differences according to GOLD classes in the following items: 1) Demographics 2) Lung Function Test 3) Exacerbations 4) Laboratory test 5) Comorbidities 6) Imaging findings <bold>Results:</bold> Patients belonging to GOLD_D class reported less frequently dyspnea (P=0.03), had a lower BMI (P = 0.001) and a better functional status in terms of 6 minutes walking distance (P= 0,002), FVC (P=0,01) and FEV1 (P = 0.002) than those classified as GOLD B. On the other hand, GOLD_D patients reported a more frequent work exposure to toxic agents (p<0.001), also presenting more consolidations and centrilobular nodules on chest-CT than GOLD A (P=0,02 and P=0,03 respectively) and GOLD B (P=0,01 and P=0,01 respectively). On multivariate analysis, work exposure to toxics, FVC% and chest-CT findings were significantly associated with GOLD_D classification. <bold>Conclusions:</bold> GOLD_D patients showed greater similarity to GOLD A rather than GOLD B in some features, while other elements seem to distinguish these classes.