Summary of Changes in 2026

CHAPTER 1: DEFINITION AND OVERVIEW

CHAPTER 2: DIAGNOSIS, ASSESSMENT AND MONITORING

CHAPTER 3: PREVENTION & MANAGEMENT OF COPD

CHAPTER 4: MANAGEMENT OF EXACERBATIONS

CHAPTER 5: COPD AND MULTIMORBIDITY

CHAPTER 6: ARTIFICIAL INTELLIGENCE AND EMERGING TECHNOLOGIES IN COPD

Document Overview

Design and created by Guideline Central in participation with the Global Initiative for Chronic Obstructive Lung Disease.

GOLD 2026 Report for Prevention, Diagnosis and Management of COPD 2026 Report

Global Initiative for Chronic Obstructive Lung Disease

Publication Date: Nov 10, 2025

Page Last Updated: May 5, 2026

Key Changes

In Chapter 1 the section on the Burden of COPD has been updated with the latest epidemiological statistics and references.
In Chapter 2 the Screening and Case-finding section has been updated and two new figures have been added (Figures 2.8 and 2.9)
Vaccination Recommendations for people with COPD have been updated with the latest information on RSV and influenza vaccination.
The criteria defining GOLD A, B and E categories have been adjusted due to emerging evidence from observational studies that even one moderate or severe exacerbation prior to initiating maintenance pharmacological therapy increases the risk of subsequent events (Figure 3.7, 3.8 and 3.9). The threshold of one moderate exacerbation should now be used to consider treatment escalation, with the aim of achieving a low disease activity state characterized by no exacerbations.
A new section on Disease Activity has been included in the report.
The Management Cycle and Treatment Algorithms in Chapter 3 have been further clarified to emphasize the distinction between INITIAL pharmacological treatment (for treatment naïve COPD patients) versus FOLLOW-UP pharmacological treatment (for patients on existing pharmacological treatment regimens) as shown in updated Figures 3.7, 3.8 and 3.9.
A new Figure 3.11 has been added to outline the evidence for the use of Biologic Therapy in COPD.
Chapter 4 – Exacerbations of COPD has been completely revised, and new figures have been introduced.
Chapter 5 – Multimorbidity in COPD has been completely revised, and new figures have been introduced.
A new Chapter 6 – Emerging Technology and COPD has been added.
The GOLD Report has been re-structured with a significant amount of text and figures moved to Appendices 1-4 to improve flow and clarity and reduce repetition.
A Table of Abbreviations has been included, and abbreviations are being used throughout the report to improve readability.
References have been checked and updated throughout the document.

Definition

COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.

Causes and risk factors

COPD results from gene(G)-environment(E) interactions occurring over the lifetime(T) of the individual(GETomics) that can damage the lungs and/or alter their normal development/aging processes.
The main environmental exposures leading to COPD are tobacco smoking and the inhalation of toxic particles and gases from household and outdoor air pollution, but other environmental and host factors(including abnormal lung development and accelerated lung aging) can also contribute.

Diagnostic criteria

In the appropriate clinical context (see ‘Definition’ & ‘Causes and Risk Factors’ above), the presence of non-fully reversible airflow obstruction (i.e., FEV1/FVC < 0.7 post-bronchodilation) measured by spirometry confirms the diagnosis of COPD.

Clinical presentation

Patients with COPD typically complain of dyspnea, activity limitation and/or cough with or without sputum production, and may experience acute respiratory events characterized by increased respiratory symptoms called exacerbations that require specific preventive and therapeutic measures.
Patients with COPD frequently harbor other comorbid diseases that influence their clinical condition and prognosis and require specific treatment. These comorbid conditions can mimic and/or aggravate an acute exacerbation.

New opportunities

COPD is a common, preventable, and treatable disease, but extensive under-diagnosis and misdiagnosis leads to patients receiving no treatment or incorrect treatment. Appropriate and earlier diagnosis of COPD can have a very significant public-health impact.
The realization that environmental factors other than tobacco smoking can contribute to COPD, that it can start early in life and affect young individuals, and that there are precursor conditions (pre-COPD, PRISm), opens new windows of opportunity for its prevention, early diagnosis, and prompt and appropriate therapeutic intervention.

Risk reduction, lifestyle and patient education

All individuals who smoke should be strongly encouraged and supported to quit. Nicotine replacement and pharmacotherapy reliably increase long-term smoking abstinence rates. Legislative smoking bans and counseling, delivered by healthcare professionals, improve quit rates. There is no evidence to support the effectiveness and safety of e-cigarettes as a smoking cessation aid at present.
People with COPD should receive all recommended vaccinations in line with the relevant local guidelines.
COVID-19 vaccines are highly effective against SARS-CoV-2 infection and people with COPD should have the COVID-19 vaccination in line with national recommendations.
Influenza, pneumococcal and RSV vaccines have been shown to decrease the incidence of lower respiratory tract infections.
The immunization committees recommend Tdap vaccination (dTaP/dTPa; pertussis, tetanus and diptheria) for people with COPD who were not vaccinated in adolescence; and routine use of shingles vaccine.

Pharmacological maintenance treatment of COPD

Initial pharmacological treatment of COPD should be individualized and guided by the severity of symptoms, risk of exacerbations, side-effects, comorbidities, drug availability and cost, and the patient’s preference, and ability to use various drug delivery devices.
Patients should be reviewed after a suitable interval (shorter in patients with more severe disease, and longer in patients with less severe disease) and reassessed for attainment of treatment goals and identification of any barriers for successful treatment.
Inhaler technique and adherence need to be assessed regularly.

Non-pharmacological treatment of COPD

Non-pharmacological treatment of COPD is complementary to pharmacological maintenance treatment and should form part of comprehensive management.
Pulmonary rehabilitation, including exercise training combined with disease-specific education, improves exercise capacity, symptoms, and quality of life across all grades of COPD severity.
LTOT should not be prescribed routinely for patients with stable COPD and resting or exercise-induced moderate desaturation, but it may improve survival in patients with severe resting chronic hypoxemia (PaO2 ≤ 55 mmHg or < 60 mmHg if there is cor pulmonale or secondary polycythemia).
Long-term NIV may be of some use in a selected group of patients, particularly those with pronounced daytime hypercapnia and recent hospitalization.

Palliative, interventional and surgical therapies

In select patients with advanced emphysema refractory to optimized medical care, surgical or bronchoscopic interventional treatments may be beneficial.
Palliative approaches are effective in controlling symptoms in advanced COPD.

An exacerbation of COPD is an acute event with symptoms worsening over a few days (up to 14 days) and characterized by increased dyspnea and/or cough and sputum that may be accompanied by tachypnea and/or tachycardia. Exacerbations are often associated with increased local and systemic inflammation caused by airway infection, pollution, or other insults to the lungs.
Although COPD exacerbations are most frequently caused by infections (viral, bacteria) or environmental pollutants, other conditions can mimic or worsen exacerbation-like symptoms. These include pneumonia, pulmonary embolism, acute heart failure, and pneumothorax. In many patients the exact cause of an exacerbation is unknown.
Exacerbation severity is classified as mild, moderate or severe based on the clinical characteristics of the patient, according to the Rome proposal.
Pharmacological therapy should be started as soon as possible to prevent both complications and subsequent events. It includes:
- SABAs, with or without short-acting anticholinergics, are recommended as the initial bronchodilators to treat moderate/severe exacerbations.
- Systemic corticosteroids are recommended for up to 5 days in patients with moderate/severe exacerbations.
- Antibiotics are recommended for a total of 5 days in patients with purulent sputum, prior history of lung infections, etc.
- Methylxanthines are not recommended due to increased side effect profiles.
High flow oxygen systems and mechanical NIV are indicated for patients with COPD and acute respiratory failure because they improve gas exchange, reduce work of breathing and the need for intubation. They also decrease hospitalization duration and improve survival.
Maintenance therapy with LABDs should be initiated as soon as possible. In patients with ≥ 1 moderate or severe exacerbation and elevated blood eosinophil levels, the addition of ICSs to a dual bronchodilator regimen should be considered at discharge.
Exacerbation recovery time varies, taking up to 4-6 weeks, with some patients failing to return to their pre-exacerbation functional state.
Following an exacerbation, the management of COPD and its comorbidities should be reviewed and appropriate measures for exacerbation prevention should be implemented (see Chapter 3).

Levels of Evidence

Evidence Category	Sources of Evidence	Definition
A	Randomized-controller trials (RCTs)	Evidence if from endpoints of well-designed RCTs that provide consistent findings in the population for which the recommendation is made without any important limitations.
A	Rich body of high quality evidence without any significant limitation or bias	Requires a high quality evidence from 2 or more clinical trials involving a substantial number of subjects, or a single high quality RCT involving substantial numbers of patients without any bias.
B	Randomized-controller trials (RCTs) with important limitations	Evidence is from RCTs that include only a limited number of patients, post hoc or subgroup analyses of RCTs or meta-analyses of RCTs.
B	Limited body of evidence	Also pertains when a few RCTs exist, or important limitations are evident (methodological flaws, small numbers, short duration, undertaken in a population that differs from the target population of the recommendation, or the results are somewhat inconsistent).
C	Non-randomized controlled trials; observational studies	Evidence is from outcomes of uncontrolled or non-randomized trials or from observational studies.
D	Panel consensus judgement	Provision of guidance is deemed valuable but clinical literature addressing the subject is insufficient. Panel consensus is based on clinical experience or knowledge that does not meet the stated criteria.

Document Overview

Document Title: Global Strategy for Prevention, Diagnosis and Management of COPD 2026 Report

Authoring Society: Global Initiative for Chronic Obstructive Lung Disease

Document Publication Date: Nov 10, 2025

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: Global

Full Text Freely Available: Yes

Full Text Guideline: goldcopd.org/wp-content/uploads/2026/01/GOLD-REPORT-2026-v1.3-8Dec2025_WMV2.pdf

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: Evidence-based strategy document for COPD diagnosis, management, and prevention, with citations from the scientific literature.

Scope: Assessment and Screening, Counseling, Diagnosis, Management, Prevention, Rehabilitation, Treatment

Diseases/Conditions (MeSH)

D029424 - Pulmonary Disease, Chronic Obstructive

Keywords: COPD, GOLD, chronic obstructive pulmonary disease (COPD)

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 1,765

Literature Search End Date: Thursday, July 31, 2025

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

GOLD 2026 Report for Prevention, Diagnosis and Management of COPD 2026 Report

Summary of Changes in 2026

Document Layout, References & Figures

Key Changes

CHAPTER 1: DEFINITION AND OVERVIEW

CHAPTER 2: DIAGNOSIS, ASSESSMENT AND MONITORING

CHAPTER 3: PREVENTION & MANAGEMENT OF COPD

CHAPTER 4: MANAGEMENT OF EXACERBATIONS

CHAPTER 5: COPD AND MULTIMORBIDITY

CHAPTER 6: ARTIFICIAL INTELLIGENCE AND EMERGING TECHNOLOGIES IN COPD

Levels of Evidence

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology