Background: The 2019 global initiative for chronic obstructive lung disease (GOLD) report made recommendations for on the assessment, initial and subsequent treatment chronic obstructive pulmonary disease (COPD) based on biomarkers, including for the first-time blood eosinophil counts. Methods: We evaluated the distribution of UK COPD patients initiating maintenance therapy as well as established patients by GOLD group, the temporal stability of the grouping and appropriateness of therapy over two years. We used electronic patient records from the Optimum Patient Care Research Database (OPCRD). GOLD group, therapy and comorbidities in 2014 on established patients and those initiating maintenance therapy that year, and changes in effective GOLD group, therapy and exacerbation rates over the next 2 years were analysed. Findings: 11,409 established COPD patients and 699 starting therapy were studied. 44.3%, 25.7%, 13.8% & 16.2% of established COPD patients and 45.2%, 28.5%, 15.7% & 10.6% initiating therapy were in GOLD groups A, B, C & D. The overall proportion in each GOLD group was similar after 2 years but there was substantial movement of individual COPD patients between groups. Diabetes and cardiovascular disease were the most common comorbidities in all groups in both cohorts. LAMA monotherapy was the commonest initial maintenance therapy in all GOLD groups. In both cohorts there was over-treatment in all groups and escalation, de-escalation or switching in nearly 50% during follow-up. In both cohorts, exacerbation rates were highest in group D and appeared higher in over-treated patients. Interpretation: Most patients are not at risk of exacerbations and co-morbidities are common. Many patients change effective GOLD group and therapy over time. Prescribing is not in accordance with guideline recommendations and many patients still appear over treated. Study Registration Number: The study protocol was registered with the European Union electronic Register of Post-Authorization studies (EUPAS25136). Funding Statement: No external funding was involved in this study. Declaration of Interests: Prof. Halpin reports personal fees from AstraZeneca, personal fees and non-financial support from Boehringer Ingelheim, personal fees from Chiesi, personal fees and non-financial support from GlaxoSmithKline, personal fees and non-financial support from Novartis, personal fees from Pfizer, outside the submitted work. He is also a member of the GOLD Board of Directors and Science Committee. Dr. de Jong, Ms Carter & Dr Skinner are employed by the Observational and Pragmatic Research Institute Pte Ltd (OPRI). Prof. Price reports grants from AKL Research and Development Ltd, personal fees from Amgen, grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants from British Lung Foundation, grants and personal fees from Chiesi, grants and personal fees from Circassia, personal fees from Cipla, personal fees from GlaxoSmithKline, personal fees from Kyorin, personal fees from Merck, grants and personal fees from Mylan, grants and personal fees from Mundipharma, grants and personal fees from Napp, grants and personal fees from Novartis, grants and personal fees from Pfizer, grants and personal fees from Regeneron Pharmaceuticals, grants from Respiratory Effectiveness Group, grants and personal fees from Sanofi Genzyme, grants and personal fees from Teva, grants and personal fees from Theravance, grants from UK National Health Service, grants and personal fees from Zentiva (Sanofi Generics), non-financial support from Efficacy and Mechanism Evaluation programme, non-financial support from Health Technology Assessment, outside the submitted work; and stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; and owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore). Ethics Approval Statement: Governance is provided and study protocol was approved by the Anonymised Data Ethics and Protocols Transparency (ADEPT) committee (ADEPT0918), an independent body of experts and regulators commissioned by the Respiratory Effectiveness Group.