The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides evidence-based, nonbiased synthesis of current literature to guide the assessment, diagnosis, and management of COPD. The GOLD 2026 report refines the clinical approach to COPD, reflecting recognition of COPD as a dynamic, heterogeneous condition shaped by ongoing biological and environmental influences. The updated strategy emphasizes individualized, proactive care aimed at controlling disease activity, preventing exacerbations, and improving long-term outcomes.1
A central conceptual update in GOLD 2026 is the reframing of COPD as a disease characterized by activity rather than by static airflow limitation alone. Disease activity is described through ongoing inflammation, symptom variability, and risk of future exacerbations. This framing directs therapeutic goals toward achieving and maintaining a “low disease activity state,” prioritizing symptom control while mitigating progression. Spirometry remains essential for diagnosis, with confirmation requiring a postbronchodilator FEV1/FVC ratio of < 0.70.2 However, GOLD encourages interpretation of spirometry alongside clinical characteristics and imaging findings when estimating burden and prognosis.
Underdiagnosis of COPD remains a persistent global challenge. The report highlights active case finding and recommends systematic evaluation of high-risk individuals, including those who currently or previously smoked and patients with unexplained dyspnea, chronic cough, or sputum production. The report also underscores opportunistic detection through existing programs, such as lung cancer screening, which may reveal previously unrecognized COPD. Updated algorithms support targeted screening and appropriate use of diagnostic spirometry to reduce delayed treatment and associated morbidity.
Risk assessment is further refined by lowering the threshold for identifying patients who are prone to exacerbations. Whereas prior clinical reports emphasized two or more moderate or severe exacerbations annually as a trigger for escalation, GOLD 2026 recognizes that even a single exacerbation meaningfully increases the probability of recurrent events. The updated framework integrates exacerbation history, symptom burden, and biomarkers to facilitate timely optimization of therapy, including consideration of blood eosinophil counts when weighing antiinflammatory strategies.
Pharmacologic therapy remains focused primarily on inhaled bronchodilators. Long-acting β-2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) persist as foundational maintenance therapies supported by improvements in lung function, symptoms, and health status. GOLD 2026 distinguishes initial therapy in newly diagnosed patients from follow-up strategies in those already receiving treatment and simplifies escalation pathways. Triple therapy (LABA/LAMA/ICS) is reaffirmed for patients with persistent exacerbations despite dual bronchodilation, particularly when blood eosinophils are elevated. Nonpharmacologic interventions—especially, smoking cessation, vaccination, and pulmonary rehabilitation—remain essential components of comprehensive care. The report emphasizes reassessment of inhaler technique, adherence, and device preference because these practical factors often determine real-world response, exacerbation risk, and overall disease course.
GOLD 2026 also incorporates emerging evidence regarding biologic therapies for COPD associated with type 2 inflammation. Agents such as dupilumab and, more recently, mepolizumab are presented as Level A evidence in selected populations, including eosinophilic phenotypes or chronic bronchitis features, with reductions in exacerbation frequency and improvement in symptom burden.3–4 These developments broaden therapeutic options beyond traditional inhaled regimens and reflect progress toward precision-based management.
Preventive strategies are updated, notably through the inclusion of recommendations regarding respiratory syncytial virus vaccination in adults aged 50 years and older.5 Influenza and pneumococcal immunizations remain strongly endorsed given the substantial contribution of respiratory infections to exacerbations, hospitalization, and mortality.
The section on exacerbation management underwent notable revision. GOLD 2026 updates definitions and severity classifications, refines criteria for outpatient vs inpatient treatment, and incorporates supportive modalities, including high-flow nasal oxygen and noninvasive ventilation.6 The report emphasizes early recognition, individualized management, and structured post-exacerbation follow-up with reassessment and optimization of maintenance therapy to prevent recurrence. Exacerbation frequency and recovery time are highlighted as clinically meaningful indicators of disease activity and future risk.
A reorganized chapter on multimorbidity reflects the high prevalence and clinical relevance of systemic comorbid conditions in COPD, including cardiovascular disease, metabolic disorders, osteoporosis, depression, and pulmonary hypertension. GOLD 2026 encourages multidisciplinary assessment and management, recognizing that comorbidities can influence symptom burden, treatment tolerance, and survival. In addition, the report introduces technological innovation, including artificial intelligence (AI) and digital health tools, as emerging adjuncts for diagnosis, monitoring, and individualized care, while advising cautious implementation with strong validation and equitable access.7
In summary, GOLD 2026 advances a contemporary model of COPD as a modifiable, biologically active disease requiring individualized and proactive management. By integrating updated evidence on case finding, exacerbation prevention, biologic therapies, vaccination, multimorbidity, and digital health innovation, the strategy provides a comprehensive framework to optimize outcomes and improve quality of life for individuals with COPD.1
Read more about the changes in the 2026 GOLD report.
References
1. Global Initiative for Chronic Obstructive Lung Disease. GOLD report 2026: key changes summary. Nov. 10, 2025. goldcopd.org/wp-content/uploads/2025/11/KEY-CHANGES-GOLD-2026-10Nov2025.pdf
2. Singh D, Stockley R, Anzueto A, et al. GOLD Science Committee recommendations for the use of pre- and post-bronchodilator spirometry for the diagnosis of COPD. Eur Respir J. 2025;65(2):2401603. doi:10.1183/13993003.01603-2024
3. Bhatt SP, Rabe KF, Martinez FJ, et al. Dupilumab for COPD with blood eosinophil evidence of type 2 inflammation. N Engl J Med. 2024;390(24):2274-2283. doi:10.1056/NEJMoa2401304
4. Sciurba FC, Criner GJ, Christenson SA, et al. Mepolizumab to prevent exacerbations of COPD with an eosinophilic phenotype. N Engl J Med. 2025;392(17):1710-1720. doi:10.1056/NEJMoa2413181
5. US Centers for Disease Control and Prevention. RSV vaccine guidance for adults. Updated July 8, 2025. www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html
6. Pantazopoulos I, Boutlas S, Mavrovounis G, et al. Nasal high flow or noninvasive ventilation in hypercapnic COPD exacerbation: randomized noninferiority trial. Respir Med. 2024;232:107762. doi:10.1016/j.rmed.2024.107762
7. Smith LA, Oakden-Rayner L, Bird A, et al. Machine learning and deep learning predictive models for long-term prognosis in COPD: systematic review and meta-analysis. Lancet Digit Health. 2023;5(12):e872-e881. doi:10.1016/S2589-7500(23)00177-2
