2025 GOLD Report: COPD Follow-Up Pharmacologic Treatment PDF Free Download
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2025 GOLD Report:
COPD Follow-Up Pharmacologic Treatment1
Full abbreviations, accreditation, and disclosure information available at PeerView.com/TTR40
a Single-inhaler therapy may be more convenient and effective than multiple inhalers.
b Consider de-escalation of ICS if pneumonia or other considerable side effects. In case of blood eos ≥300 cells/mcL, de-escalation is more likely to be associated with the development of exacerbation.
1. Global Initiative for Chronic Obstructive Lung Disease. 2025 Report. https://goldcopd.org/2025-gold-report.
Dyspnea
• Consider switching inhaler device
or molecules
• Implement or escalate
nonpharmacologic treatment(s)
• Consider adding ensifentrine
• Investigate (and treat) other
causes of dyspnea
LABA or LAMA
LABA + LAMAa
Preferentially in
former smokers
Exacerbations
If blood
eos <100
If blood
eos ≥100
LABA or LAMA
LABA + LAMAa
LABA + LAMA + ICSa
Roflumilast
FEV1 <50% and
chronic bronchitis
Azithromycin
preferentially in
former smokers
If blood
eos <300
If blood
eos ≥300
b
Dupilumab
chronic
bronchitis
For
predominant
type 2
inflammation
1. If response to initial treatment is appropriate, maintain it
2. If not: check adherence, inhaler technique, and possible interfering comorbidities; consider predominant treatable trait
to target (dyspnea or exacerbations); use exacerbation pathway if both exacerbations and dyspnea need to be targeted;
place patient in box corresponding to current treatment and follow indications; assess response, adjust, and review
(these recommendations do not depend on ABE assessment at diagnosis)
Identifying COPD Patients at Risk for Exacerbations
Full abbreviations, accreditation, and disclosure information available at PeerView.com/TTR40
1. Rossi A et al. Int J Chron Pulm Dis. 2017;12:2593-2610. 2. Ertan Yazar E et al. Medeni Med J. 2022;37:173-179. 3. Minov J et al. Med Sci (Basel). 2017;5:7. 4. Tesfaigzi Y et al. Clin Appl Immunol Rev. 2006;6:21-36. 5. Bigatao AM et al. Ann Surg. 2018;84:51-55.
6. Ruanne L et al. Eur Respir J. 2019;54:OA272. 7. Bhatt SP et al. Am J Respir Crit Care Med. 2023;208:1026-1041. 8. Singh D et al. Am J Respir Crit Care Med. 2022;206:17-24.
Lung Function1
Patients with mild
and moderate airflow
obstruction can also
have exacerbations
Structural or
Functional
Abnormalities3,4
Bronchiectasis; poor
mucus clearance
Symptom Burden2
Use mMRC
Dyspnea Scale
and CAT scores
Underrecognized
or Unrecognized
Etiologies5-7
eg, GERD,
heart failure
Increased Blood
Eosinophil Counts
and Sputum
Eosinophils8
