Background Previous versions of the GOLD strategy algorithm recommended treatment based on FEV1 which is now recognised as a poor descriptor of disease impact. The revised 2011 GOLD document has introduced individualised assessment of symptoms and future risk for initial management of stable COPD. Questionnaires such as COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) are suggested to assess symptoms and risk depends on spirometric impairment or exacerbation frequency.

Aim To apply the current GOLD treatment algorithm to AATD patients and assess their current treatment against that recommended.

Methods 309 consecutive patients on the AATD registry (PiZZ) were grouped into the four categories (A, B, C, and D) as suggested by GOLD, on the basis of their CAT 10, 13 or mMRC scores and GOLD spirometric stage or Exacerbation frequency. We then documented the treatment combinations being used by the patients in the different groups.

Results Treatment for patients in the four groups differed widely from GOLD recommendations. Few patients in Group A(CAT10GOLD/MRCGOLD/CAT13GOLD:6%/2%/2% and CAT10EXAC/MRCEXAC/CAT13EXAC:6%/2%/3%) were on the GOLD recommended SABA/SAMA therapy. 40% were on none and 30% were on triple therapy. The majority of patients in group B and Group C (60% and 58% respectively) were on triple therapy with only 10% and 14% respectively being on the recommended regimen. Nearly 70% in group D were on recommended triple therapy with ICS, LABA and LAMA.

The proportion of patients in the groups A, B and C assessed by mMRC was significantly different using CAT 10 (p<0.02) but not using CAT 13 (p = not significant). The proportion of patients in group D was similar for all 3 symptom scores (p = not significant).

Conclusions CAT 13 was most comparable to mMRC for patient distribution. Most of the AATD patients with low risk (low symptoms and high symptoms) were over treated with triple therapy. The majority in the high risk/high symptoms group were appropriately on triple therapy. It remains to be determined how this affects long term outcome.