Advanced Chronic Obstructive Pulmonary Disease: Symptoms, Remedies, and Prognosis
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released its 2025 guidelines, emphasizing a more precise, biomarker-informed approach to diagnosing and treating COPD.
Diagnosis
The gold standard for diagnosing COPD remains spirometry, which measures the amount and speed of air you exhale. This test is particularly important for patients undergoing lung cancer screening or those with relevant symptoms. Early screening of symptomatic smokers or those with risk factors is now given greater emphasis to allow for earlier diagnosis.
Staging and Grouping
Patients are no longer solely classified by their forced expiratory volume in 1 second (FEV1). Symptom severity (such as the CAT score and mMRC scale) and exacerbation history are also taken into account. However, the traditional GOLD groups have been found to be "mediocre" predictors of future exacerbations and mortality, leading to reconsideration of cutoffs and models for risk stratification.
Treatment Recommendations
Nonpharmacological management, including smoking cessation, vaccinations, and pulmonary rehabilitation, is recommended for all patients. Pharmacological treatment is aligned with the GOLD group. For lower-risk groups, monotherapy with bronchodilators (LAMA or LABA) is recommended. If a patient's blood eosinophil count (AEC) is 300/μL or higher, indicating a likely response to inhaled corticosteroids (ICS), the addition of ICS is recommended. For those with lower AEC who remain symptomatic, switching to dual bronchodilator therapy (LAMA/LABA) is preferred.
Differences from Previous Guidelines
The integration of blood eosinophil counts as a biomarker to guide ICS use in stable COPD treatment is a new, evidence-based update. The limitations of current GOLD exacerbation groups in predicting outcomes have been highlighted, suggesting future refinement of staging. Greater emphasis is placed on individualized treatment decisions, incorporating biomarkers and more dynamic risk assessment. The guidelines now recommend COPD screening for patients undergoing lung cancer screening, broadening early diagnosis opportunities.
In advanced COPD, consider long-term oxygen therapy and interventions such as lung volume reduction surgery.
The 2025 GOLD guidelines represent an evolution towards more precise, biomarker-informed treatment based on comprehensive risk assessment, improving over prior versions that relied more solely on spirometric cutoffs and exacerbation frequency without biomarker stratification.
Research suggests that long-term exposure to air pollution may increase the risk of developing COPD.
- The 2025 guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) suggest a more personalized approach to COPD treatment, considering factors such as blood eosinophil counts as biomarkers.
- Due to the limitations of the traditional GOLD groups in predicting exacerbations and mortality, future refinement of staging and risk stratification is being considered.
- Screening for COPD, particularly for symptomatic smokers and those with risk factors, is now emphasized to allow for earlier diagnosis and treatment.
- Medical professionals are urged to incorporate a comprehensive risk assessment, including biomarkers, when making individualized treatment decisions for chronic respiratory conditions like COPD. This shift towards a biomarker-informed strategy may help manage chronic diseases and improve health and wellness outcomes.
