The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released its newly revised 2026 report, featuring important updates for clinicians.1 Key points include a renewed focus on identifying untreated patients and a revised chapter on COPD exacerbations.
“Even with one moderate exacerbation, within the next 30 days you are at greater risk for a major acute cardiac event, whether that’s arrhythmia, stroke, ischemic heart disease, or heart failure,” said Gerard J. Criner, MD, FCCP, a member of the GOLD Science Committee. “The link between even one moderate exacerbation for lung and cardiovascular health is substantial. We want to lower the threshold for treatment and bring awareness to treating exacerbations because of the consequences of worsening lung function, quality of life, and cardiovascular health.”
Improving patient identification and case finding is another key focus. Multiple studies have pointed to the chronic underdiagnosis and undertreatment of COPD. Dr. Criner said there is strong evidence indicating that earlier intervention improves outcomes. There is similarly robust evidence that clinicians can better identify and monitor individuals at risk for COPD through risk assessment tools such as case finding questionnaires or risk prediction models.1
“If you [conduct] lung cancer screening, those patients are at risk for COPD (based on smoking history),” said Dr. Criner, Professor and Chair of Thoracic Medicine at the Lewis Katz School of Medicine at Temple University. “Asking questions about COPD and performing spirometry would be useful to identify people who are underdiagnosed and thereby undertreated. Identify people in your clinic population who are at risk, give them questionnaires, and try to give them spirometry depending on the pretest questionnaire. We are talking more about case finding to improve outcomes.”
Smoking, however, is not the only contributing factor. COPD has multiple etiologies, some of which can begin in utero due to poor developmental growth. Conditions such as bronchopulmonary dysplasia and delayed lung maturation can contribute to airway obstruction. Additionally, childhood illnesses, wildfire smoke exposure, and other environmental factors throughout life can also play a role.
“A lot of those factors can be hard to capture, unlike a known history of tobacco smoking, but there is growing recognition that it’s not just smoking that can lead to chronic airway obstruction,” Dr. Criner said.
The 2026 update also provides more precise definitions of disease activity. COPD exhibits fewer characteristic pathological changes or biomarkers compared with systemic inflammatory diseases, such as rheumatoid arthritis or ulcerative colitis, Dr. Criner said. However, combining changes in patient-reported symptoms with alterations in objective markers—such as lung function, airway mucus plugging observed on imaging, or blood eosinophil counts—can help.
The goal is to assess the disease state in terms of stability and control. Disease stability is a low disease activity state with no exacerbations, no worsening of symptoms, and no accelerated loss of lung function.1 Disease control focuses on a state of low disease activity, which is defined as the absence of exacerbations and symptom progression.1 Treatment aims to reduce disease activity by achieving either stability or control, recognizing that success in either is likely to vary depending on individual patient characteristics.
It is also important to more precisely define “exacerbation.” Multiple studies have found that about one-third of individuals who are hospitalized with COPD are not experiencing an exacerbation and have been admitted for issues unrelated to lung function.
There is also a significant population with COPD symptoms who are not hospitalized but may still experience severe events. GOLD has clarified the criteria for admission, ICU care, and discharge.
Biologics can and should be considered for patients on triple inhalation therapy who continue to experience exacerbations, and the US Food and Drug Administration has approved two for COPD: dupilumab and mepolizumab.
Earlier use of biologics is likely to benefit patients by providing improved stability and control earlier in the course of the disease, Dr. Criner said, but that is a topic that requires further study.
Additionally, the 2026 report includes a new chapter on artificial intelligence (AI) and emerging technologies in COPD. For more details, read “AI-enabled approaches poised to transform diagnosis, management of lung diseases.”
References
1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for Prevention, Diagnosis, and Management of COPD: 2026 Report. Version 1.3. December 8, 2025. https://goldcopd.org/wp-content/uploads/2025/12/GOLD-REPORT-2026-v1.3-8Dec2025_WMV.pdf
