GOLD Recommendations

Review COPD management strategies with GOLD Report recommendations

The GOLD Report recommends LAMA maintenance treatment for patients in Groups B and E2*†

Initial pharmalogical treatment2*†

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Following implementation of therapy, patients should be reassessed for attainment of treatment goals.

*GOLD does not endorse any individual product.

†In 2024, the GOLD Report grouped patients into 3 categories. Groups C and D are combined into Group E.

‡Single inhaler therapy may be more convenient and effective than multiple inhalers; single inhalers improve adherence to treatment.

Management cycle2

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The number of different device types should be minimized for each patient. Ideally only one device type should be used.10-11

Follow-up pharmacological treatment2§

If response to initial treatment is appropriate, maintain it. If not:

  • Check adherence, inhaler technique, and possible interfering comorbidities
  • The need to target primarily dyspnea/activity limitation or to prevent further exacerbations should be evaluated in each patient. Consider the predominant treatable trait to target (dyspnea or exacerbations)
    • Use the exacerbation pathway if both exacerbations and dyspnea need to be targeted
  • If a change in treatment is considered necessary, then select the corresponding algorithm for dyspnea or exacerbations
  • Identify which box corresponds to the patient's current treatment and follow the suggested algorithm

§GOLD does not endorse any individual product.

Single inhaler therapy may be more convenient and effective than multiple inhalers; single inhalers improve adherence to treatment.

Consider de-escalation of ICS if pneumonia or other considerable side effects. In case of blood eos ≥300 cells/µl, de-escalation is more likely to be associated with the development of exacerbations.

Exacerbations refers to the number of exacerbations per year.

 

© 2025 Global Strategy for Diagnosis, Management and Prevention of COPD. All rights reserved. Use is by express license from the owner.

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CAT=COPD Assessment Test; COPD=chronic obstructive pulmonary disease; eos=blood eosinophil count in cells per microliter;
FEV1=forced expiratory volume; GOLD=Global Initiative for Chronic Obstructive Lung Disease; ICS=inhaled corticosteroid;
LABA=long-acting beta2-agonist; LAMA=long-acting muscarinic antagonist; mMRC=Modified Medical Research Council.