What is the refined ABCD assessment tool for COPD?

Refined ABCD assessment tool for COPD:

It is a revised COPD assessment tool where spirometric grading of airflow limitations is combined with the patient's self-assessment of the symptoms and history of exacerbations and hospital admission attributed to the COPD exacerbations. 

GOLD (Global initiative for chronic Obstructive Lung Disease) grade is used for the stratification of the airway limitations considering patient's Force expiratory volume in the first second (FEV1). Administration of an adequate dose of at least one short-acting inhaled bronchodilator is required to minimize variability. Specific spirometric cut-points are used. 

[GOLD classification of airflow limitation in COPD]

Patient's assessment of symptoms is done by two methods; 

a. the Modified British Medical Research Council (mMRC) dyspnea scale; and b. COPD Assessment Test (CAT)

mMRC dyspnea scale:

[The modified mMRC questionnaire]

CAT assessment:

[COPD Assessment Test (CAT)]

Refined ABCD assessment tool: 

[The Refined ABCD assessment tool]

Example of the effectiveness of the new refined ABCD assessment tool: 

Consider two patients - both patients with FEV1 < 30% of predicted, CAT scores of 18 and one with no exacerbations in the past year and the other with three moderate exacerbations in the past year. Both would have been labelled GOLD D in the prior classification scheme. However, with the new proposed scheme, the subject with three moderate exacerbations in the past year would be labelled GOLD grade 4, group D; the other subject with no exacerbations would be labelled GOLD Grade 4, group B. 

[Source: goldcopd.org]