Guidelines

The 2025 GOLD recommendations assign patients’ chronic obstructive pulmonary disorder (COPD). Symptoms and exacerbation risk across three groups: A, B and E. Once a group is assigned, initial pharmacologic treatment is described for each individual group. The treatment of patients in Group A has not changed. In contrast, for patients in Group B, a dual long-acting bronchodilator combination (β2 adrenergic [LABA] and an anti-muscarinic [LAMA] bronchodilator) is now recommended since dual therapy is more effective than monotherapy, with similar side effects. For patients in Group E, LAMA + LABA is also the recommended initial therapy, except for patients with blood eosinophils > 300 cells/μL, in whom starting triple therapy (LABA + LAMA + immune checkpoint inhibitor [ICI]) can be considered. The important predictive roles of the blood eosinophil count, exacerbation risk, and response to ICS are discussed below.¹