Updates to Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report Released

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Updates have been added in the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report, with 3 new sections and several revisions made to existing topics to reflect recent developments in chronic obstructive pulmonary disease (COPD) care and research.^1,2

These updated guidelines were presented by Claus F. Vogelmeier, MD, who serves as chair of the GOLD science committee and as professor at Philipps University of Marburg.³ He highlighted several of the most notable adjustments made to the report during the 2024 GOLD COPD conference.

Here, the HCPLive editorial team has highlighted an array of these guideline updates and new sections which were covered in the latest report:

Added Sections to 2025 GOLD Report

One of the new sections featured in the report highlights cardiovascular risk in COPD. Cardiovascular issues were noted as a significant concern in COPD management, affecting even patients deemed to be stable.

This new section includes a note that those with COPD may often also suffer from cardiovascular issues, though these may be ignored by an attending clinician based upon his or her area of expertise. Exacerbations of COPD, described as ECOPD, were shown to be linked with increased risk of cardiovascular issues, potentially resulting from lung vessel compression, inflammation, or hypoxemia.

In terms of recommendations, these included structured follow-ups following occurrences of ECOPD to evaluate and address any related comorbidities.
Another section covered pulmonary hypertension. In this new section, the necessity of a tailored approach to COPD management among individuals with pulmonary hypertension was delved into. This was also shown to depend on the underlying classification, given differences between group 3 versus group 1 or 4 pulmonary hypertension.

In this section, a figure was included that breaks down how physicians should manage individuals who have pulmonary hypertension-COPD based on the aforementioned pulmonary hypertension groups.

Thirdly, a section of the effects of global climate change was included in the report. This portion is aimed at addressing such impacts, with extreme weather such as heat and cold having been shown to affect COPD exacerbations as well as hospitalizations.

Higher outdoor temperatures were shown to be linked with an increased risk of hospitalization for those with COPD. Conversely, lower outdoor temperatures were linked with a risk increase for exacerbations.³

This new section on environmental impacts highlights the combined risks of air pollution and heat, which were demonstrated to elevate all-cause mortality in patients who are affected.

Revisions to Existing GOLD Report Sections

A revision was added which highlighted spirometry. There were updates designed to address diagnostic thresholds. Additionally, considerations were made to such subjects as race-neutral lung function equations and possible overdiagnosis risks among individuals who are older adults.

Another revision was made related to CT Imaging. Specifically, the report included current details on CT scan utilization for the detection of nodules, COPD-associated morbidities, and emphysema.

An additional revision covered pharmacological treatments. Information added on the roles of recently-approved medications such as dupilumab as well as ensifentrine for specific subgroups of COPD patients. Ensifentrine is a novel, first-in-class dual-inhibitor of both PDE3 and PDE4 which is inhaled and currently only accessible in the US.

Specifically, the suggestion to consider adding ensifentrine was listed when patients on long-acting β2 agonists (LABAs) plus long-acting muscarinic antagonists (LAMAs) still have substantial levels of symptoms.³

For dupilumab, a pooled analysis of 2 recent studies had suggested that treatment with 300 mg dupilumab on an every-2-week basis resulted in improvement in patients' annualized exacerbation rate and pre-bronchodilator FEV1 at Week 52 among individuals who are current/former smokers who have moderate to severe COPD as well as type 2 inflammation (blood eosinophil count 300 cells/μL).³

Dupilumab has now been listed in the figure titled 'Follow-up Pharmacological Treatment' as a therapy option, provided those on ICS plus LABA plus LAMA continue to have exacerbations and meet the aforementioned eosinophil count.

Additionally, there was a revision related to inhaled corticosteroids (ICS) withdrawal guidance. Includes a new framework for determining whether or not a cessation or continuation of ICS should be carried out. The revision favored triple therapy when indicated.

References

1. ^{Global initiative for chronic obstructive lung disease 2025 report. https://goldcopd.org/wp-content/uploads/2024/11/GOLD-2025-Report-v1.0-12Nov2024_WMV-Draft.pdf. Date accessed: November 17, 2024.}
2. ^{GOLD report 2025 key changes summary. https://goldcopd.org/wp-content/uploads/2024/11/KEY-CHANGES-GOLD-2025-11Nov2024.pdf. Date accessed: November 17, 2024.}
3. ^{Hornick I. 2025 GOLD report addresses cardiovascular risk, climate change, pulmonary hypertension. Healio. November 14, 2024. https://www.healio.com/news/pulmonology/20241114/2025-gold-report-addresses-cardiovascular-risk-climate-change-pulmonary-hypertension#:~:text=The%202025%20report%20also%20features,the%20figure%20in%20the%20report. Date accessed: November 17, 2024.}