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Background The severity of COPD exacerbations results from a combination of acute deterioration and baseline conditions initiated by an intrinsic or extrinsic trigger. Current classifications, such as the 2023 GOLD-adopted Rome classification, focus mainly on treatment given and hospitalisation, overlooking the dynamic relationship between baseline health and exacerbation events.Aim To develop and evaluate a COPD exacerbation severity stratification model that addresses acute presentations and transitions between clinical stability and worsening disease.Method A model to incorporate different dimensions, all that contributing to the severity of exacerbations, was developed through a series of workshops across European clinicians and patient feedback, developed through the CICERO ERS Clinical Research Collaboration. The model is currently being validated in cohorts of hospitalised patients in the UK and Belgium.Result The BAT (Baseline, Acuity, Trigger) model incorporates three domains: Baseline (B), functional status of chronic disease; Acuity (A), severity of the acute illness; and Trigger (T), aetiologies triggering the event, allowing personalised treatment (left of figure 1). The BAT model stratifies exacerbations into low, moderate, or high risk, guiding healthcare facility, likelihood of deterioration, and recovery timelines (right of figure 1). Although data analysis is ongoing, early findings indicate that the BAT model outperforms the Rome classification in predicting mortality, with stronger alignment between severity grading and patient outcomes.Abstract P4 Figure 1Multidimensional classification of severity of acute exacerbation of COPD (AECOPD) according to ‘Baseline’ (B), ‘Acuity’ (A) and ‘Triggers’ (T): The BAT model stratifies AECOPD events into low, moderate, or high risk by assessing three key domains: Baseline (B): Evaluate baseline health using lung function test (FEV1), functional disability due to breathlessness (mMRC scale), clinical frailty scale, and body mass index (BMI). Acuity (A): Assess the degree of worsening dyspnoea burden, multi-organ involvement, and acute ventilatory failure on admission. Trigger (T): Gather information on the exacerbation triggers (e.g., respiratory infection, eosinophilia, or mimics) to formulate personalised treatment for the current event and phenotype/mitigate the risk of future AECOPD eventsConclusion The BAT classification may allow more individualised prognostic and therapeutic implications. Further validation across both community and hospital settings is needed to confirm its broader utility and applicability.