The Global Initiative for Obstructive Lung Disease (GOLD) released its 2026 report earlier this week, adding more than 300 relevant references from clinical research to the organization’s annually updated guidance on the definition, diagnosis, assessment, prevention, and management of COPD.1
This year’s report made several significant alterations to the clinical definitions that comprise COPD, including the shift to constitute any patient who has experienced ≥1 moderate or severe exacerbation in the last year to be classified as “exacerbated.” Previously, patients were required to have ≥2 exacerbations to reach this mark. This update was based on observational research showing that just 1 exacerbation prior to initiating maintenance pharmacotherapy could increase the risk of subsequent events — thereby warranting that clinicians consider treatment escalation at the threshold of 1 exacerbation in order to achieve low disease acidity state.
The 2026 report additionally provided recommendations for goal-setting, monitoring, and prescribing / maintaining therapy for “stable COPD” — a previously less-defined state of disease without worsening markers nor symptoms.
Further, the report introduced the role of artificial intelligence (AI) in COPD detection, management, and research — setting the groundwork for further organization-level recommendations surrounding large language models (LLMs) and other AI tools to optimize COPD care.
In an interview with HCPLive during the 2025 GOLD International COPD Conference in Philadelphia, PA, this week, Claus Vogelmeier, MD, a professor at the University of Marburg and chair of the GOLD science committee, discussed the biggest updates to the annual report and what it means for the current and future priorities in COPD care progression.
Regarding the updated exacerbation classification, Vogelmeier noted the change does not affect initial COPD treatment — patients will still likely be initiated on long-acting beta agonist (LABA) plus an anticholinergic. But it will implicate future treatment, as it qualifies patients immediately for care escalation.
“We have learned over time that having an exacerbation, even moderate ones, can be very risky for the patients,” Vogelmeier said. “They may go to the hospital, they may need to be treated with steroids and/or antibiotics, they may lose lung function, they may lose quality of life. So with this as a background, we decided that we have to change the system.”
Vogelmeier explained that increasingly robust data on the clinical efficacy and safety of newer therapies to treat COPD, including triple-therapy inhaler devices and the recently approved biologic mepolizumab, gives him and the committee assurance that treatment escalation is worthwhile for patients after their first COPD exacerbation.
Regarding the addition of a second biologic to the annual GOLD report — following dupilumab — Vogelmeier acknowledged that more biomarkers need to become established in COPD, in order to reflect the metrics of treatment success with modern therapy.
“Most of the treatment decisions that we make are based on clinical parameters,” Vogelmeier said. “We have to move on to biological parameters, so we have to go from phenotype to endotype.”
The concept of “disease stability,” added to the GOLD report, reflects the increasing opportunity to reduce COPD activity in patients with the wider armamentarium of treatments now available.
“There are now the first data suggesting when patients are stable over certain periods of time, their prognosis will get better,” Vogelmeier said. “And this is not only good as an end point for future studies, that we try to have a composite endpoint that tells us about disease stability or control — but in addition to that, it also tells us how we can communicate better with patients. If they are doing well, we should tell them. And as you know, wording is extremely important.”
References
- Global Initiative for Chronic Obstructive Lung Disease. 2026 GOLD Report and Pocket Guide. Web page. Accessed November 14, 2025. https://goldcopd.org/2026-gold-report-and-pocket-guide/
- Johnson V. FDA Approves Mepolizumab for Eosinophilic COPD. HCPLive. Published online May 22, 2025. https://www.hcplive.com/view/fda-approves-mepolizumab-for-eosinophilic-copd
