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The 2027 GOLD report recommends a LAMA for group A, defines 6 pre-COPD types, and expands CT, rehabilitation, and cardiovascular guidance for COPD.
The 2027 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report recommends a long-acting muscarinic antagonist (LAMA) as initial therapy for patients in GOLD group A and expands guidance on CT imaging, nonpharmacologic care, and cardiovascular comorbidities, according to a presentation at the GOLD 2026 COPD International Conference in Philadelphia.¹
Claus F. Vogelmeier, MD, chair of the GOLD Science Committee, outlined the key revisions, and Alvar Agustí, MD, chair of the GOLD Board of Directors, introduced a separate Science Committee call to action. The full report is expected online on World COPD Day, November 18.
A new section, developed with the Global Initiative for Asthma, addresses challenges shared by COPD and asthma, including limited access to diagnostic testing, inhaler availability and affordability, and climate impact. The report also clarifies terminology: early COPD should not be used in clinical settings, mild COPD should describe only spirometric severity, and COPD in young individuals refers to patients younger than 50 years.
Pre-COPD now spans 6 presentations in individuals with normal spirometry: preserved ratio impaired spirometry, airflow limitation resolving after bronchodilation, CT evidence of emphysema or airway wall thickening, chronic bronchitis symptoms in smokers, reduced diffusing capacity, and accelerated lung function decline.
An expanded spirometry section, written with the Global Lung Function Initiative, concludes neither the 0.70 fixed ratio nor the lower limit of normal is intrinsically superior, and the choice makes little practical difference. For borderline results, Vogelmeier said further investigation and repeat testing may be warranted.
The CT section, previously limited to differential diagnosis, lung volume reduction, and lung cancer screening, now covers mucus plugging, which Vogelmeier described as a priority for future evaluation. He cited COPDGene data linking airway-occluding plugs to higher mortality³ and a CT substudy of approximately 700 patients from the OBERON and TITANIA trials showing dose-dependent plug reduction with tozorakimab, though the clinical implications remain unknown.
CT can also identify comorbidities, including coronary artery calcification, sarcopenia, and osteoporosis, and help evaluate persistent symptoms despite optimized treatment.
The only substantive pharmacologic change replaces the general bronchodilator recommendation for group A with a LAMA, based on a systematic review. Vogelmeier highlighted a Chinese trial of approximately 800 patients with GOLD 1 or 2 disease, most of them treatment naive, in which tiotropium improved FEV1 and reduced exacerbations compared with placebo.² New biologics remain outside the algorithm until approved by the FDA or EMA, although published data for tozorakimab and astegolimab are reviewed in the text.
Nonpharmacologic recommendations now mirror the pharmacologic ABE framework, with evaluation for pulmonary rehabilitation recommended at diagnosis for groups B and E. The chapter distinguishes physical activity coaching, exercise training, and pulmonary rehabilitation, and calls for physical activity programs after exacerbations managed at home.
A revised cardiovascular section, developed with cardiologist Chris Gale, notes standard risk calculators underestimate cardiovascular risk in COPD, with coronary calcium scoring improving prediction of major adverse cardiovascular events. SGLT2 inhibitors and cardioselective β-blockers are recommended across heart failure types, and no rate or rhythm control strategy for atrial fibrillation is contraindicated.
Agustí described the call to action as aspirational rather than a guideline. It urges prevention beyond smoking, earlier diagnosis, and personalized management, along with research into whether COPD identified at younger ages could be cured or brought into remission.
Editor’s Note: This summary of a session has been edited for grammar and clarity using artificial intelligence tools.
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