Guidelines

The 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations categorize patients with chronic obstructive pulmonary disorder (COPD) into three groups: A, B and E—based on symptom burden and exacerbation risk. Following group assignment, initial pharmacologic treatment is tailored for each group. Treatment recommendations for Group A remain unchanged: offer either a short- or a long-acting bronchodilator. For Group B, dual long-acting bronchodilator therapy combining a long-acting β2-agonist (LABA) and a long-acting anti-muscarinic (LAMA), is now recommended as initial therapy, given its superior efficacy compared to monotherapy with comparable side effects. Similarly, for Group E, LAMA + LABA is the preferred initial therapy; however, in patients with blood eosinophils >300 cells/μL, initiating triple therapy (LABA + LAMA + inhaled corticosteroid [ICS]) may be considered. In patients treated with LABA+LAMA+ICS (or those with EOS <100 cells/µL) who still have exacerbations, treatment with azithromycin or roflumilast is defined for specific patient characteristics. Additionally, in those patients with EOS ≥300 cells/µL and symptoms of chronic bronchitis, dupilumab is a recommended treatment option. The predictive significance of blood eosinophil counts, exacerbation risks, and response to ICS is discussed below.¹