Escalate therapy earlier in COPD exacerbations

In a major revision to its annual report on COPD, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strongly recommends earlier escalation of therapy following even a single exacerbation

GOLD warns that even one moderate or severe exacerbation before initiating maintenance therapy increases the risk of further exacerbations, and this risk increases if exacerbations are frequent or severe.

Increased severity and frequency of exacerbations are also the greatest risk factors for all-cause, COPD- and cardiovascular disease (CVD)-related mortality.

GOLD has revised its criteria for defining treatment categories, based on exacerbations and symptoms, and recommends that, in addition to tailoring treatment according to the level of the patient’s symptoms and risk of exacerbation, it should be escalated if the patient continues to experience exacerbations while on maintenance therapy. The report also recommends the use of additional drugs, including biologics, for patients with persistent exacerbations.

The report states: ‘Exacerbations of COPD are important events because they negatively impact health status, worsen airflow obstruction, disease progression, rates of hospitalisation and readmission, and risk of death. Many exacerbations are not reported to healthcare professionals, and yet these events, although often shorter in duration, also have a significant impact.’

GOLD has also completely revised the chapter of the report on comorbidities: it says multimorbidity is often underdiagnosed and undertreated, and should be actively searched for in all COPD patients. Other long term conditions, including CVD, obesity, frailty, lung cancer and depression and anxiety complicate the management of COPD and significantly affect prognosis.

GOLD 2026 Report and Pocket Guide

https://goldcopd.org/2026-gold-report-and-pocket-guide