GOLD 2026 Report: Global Strategy for the Diagnosis, Management, and Prevention of COPD

Essential vocabulary, diagnostic criteria, classification tools, and pharmacotherapeutic concepts from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 Report.

Chronic Obstructive Pulmonary Disease (COPD)

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.

GETomics

The conceptual framework proposing that COPD results from complex gene ($G$)-environment ($E$) interactions occurring over the lifetime ($T$) of an individual that can damage the lungs and/or alter normal lung development and aging processes.

Pre-COPD

A term identifying individuals of any age who have respiratory symptoms and/or detectable structural or functional lung abnormalities in the absence of airflow obstruction on forced spirometry ($FEV_1/FVC \ge 0.7$ post-bronchodilation).

Preserved Ratio Impaired Spirometry (PRISm)

A spirometric pattern defined by a preserved ratio ($FEV_1/FVC \ge 0.7$ post-bronchodilation) accompanied by a reduced forced expiratory volume in $1$ second ($FEV_1 < 80\%$ of reference/predicted post-bronchodilation).

Dysanapsis

An anthropometric mismatch between airway tree caliber and total lung volume, which is associated with baseline airflow obstruction and the risk of incident COPD independently of age, sex, height, and race/ethnicity.

Young COPD

COPD occurring in individuals aged $20\text{--}50\,\text{years}$, often associated with a failure to achieve normal peak lung function in early adulthood, a shortened plateau, or accelerated early decline.

Chronic Bronchitis

A clinical condition defined by the presence of chronic cough and sputum production for at least $3\,\text{months}$ per year for two consecutive years, in the absence of other explanatory conditions.

COPD Etiotypes

A taxonomy classifying COPD based on distinct underlying causal exposures and mechanisms, including genetically determined ($\text{COPD-G}$), abnormal lung development ($\text{COPD-D}$), cigarette smoking ($\text{COPD-C}$), biomass/pollution exposure ($\text{COPD-P}$), infections ($\text{COPD-I}$), asthma-associated ($\text{COPD-A}$), and unknown cause ($\text{COPD-U}$).

Spirometry Volume-Time Curve in Airflow Obstruction

A spirometric tracing demonstrating a disproportionate reduction in $FEV_1$ relative to $FVC$, leading to a post-bronchodilator ratio of $FEV_1/FVC < 0.70$ (e.g., $FEV_1 = 1.8\,\text{L}$, $FVC = 3.2\,\text{L}$, $FEV_1/FVC = 0.56$) along with a prolonged expiratory time.

GOLD Grades 1–4

Spirometric classification of airflow obstruction severity in patients with $FEV_1/FVC < 0.7$ based on post-bronchodilator $FEV_1$: GOLD 1 (Mild, $FEV_1 \ge 80\%$ predicted); GOLD 2 (Moderate, $50\% \le FEV_1 < 80\%$ predicted); GOLD 3 (Severe, $30\% \le FEV_1 < 50\%$ predicted); and GOLD 4 (Very Severe, $FEV_1 < 30\%$ predicted).

Chronic Airways Assessment Test (CAAT™)

An 8-item multidimensional patient-completed questionnaire (previously CAT™) designed to evaluate health status impairment in chronic airways disease, scored from $0$ to $40$, where a score $\ge 10$ denotes high symptom burden.

Modified Medical Research Council (mMRC) Dyspnea Scale

A 5-point validated questionnaire rating disability attributable to breathlessness from grade $0$ to $4$, where a score $\ge 2$ separates 'less breathlessness' from 'more breathlessness' in clinical assessment.

GOLD ABE Assessment Tool

A classification scheme for initial pharmacological management stratifying patients into Group A ($0$ moderate/severe exacerbations per year, $mMRC < 2$ or $CAAT < 10$), Group B ($0$ moderate/severe exacerbations per year, $mMRC \ge 2$ or $CAAT \ge 10$), and Group E ($\ge 1$ moderate or severe exacerbations in the previous year, irrespective of symptom level).

COPD Exacerbation

An acute event with worsening of respiratory symptoms over a few days (up to $14\,\text{days}$), characterized by increased dyspnea and/or cough and sputum, often accompanied by tachypnea and/or tachycardia, and associated with local and systemic inflammation.

Rome Classification of Exacerbation Severity

A clinical grading framework classifying exacerbations at point-of-care into Mild ($VAS < 5$, $RR < 24\,\text{breaths/min}$, $HR < 95\,\text{bpm}$, $\text{SaO}_2 \ge 92\%$, $CRP < 10\,\text{mg/L}$); Moderate (meeting $\ge 3$ of $5$ elevated thresholds); or Severe (meeting moderate criteria plus arterial hypoxemia $\text{PaO}_2 \le 60\,\text{mmHg}$ and/or hypercapnic acidosis $\text{PaCO}_2 > 45\,\text{mmHg}$ and $pH < 7.35$).

Disease Activity (COPD)

Biologically modifiable pathways that drive the pathological progression of COPD; achieving low disease activity requires suppressing three clinical targets: no exacerbations, no worsening of symptoms, and no accelerated decline in lung function.

Disease Stability vs. Disease Control

Disease stability is a low disease activity state characterized by no exacerbations, no symptom worsening, and no accelerated lung function loss; disease control requires achieving disease stability plus low symptom impact ($CAAT < 10$ or $mMRC < 2$).

Dynamic Hyperinflation

A temporary increase in end-expiratory lung volume above resting values that develops when expiratory flow limitation and shortened expiratory time during increased ventilatory demand (such as exercise) prevent complete lung emptying.

Blood Eosinophil Count

A circulating biomarker used to predict the responsiveness to inhaled corticosteroids (ICS) added to long-acting bronchodilators, where counts $< 100\,\text{cells/}\mu\text{L}$ identify low likelihood of benefit and counts $\ge 300\,\text{cells/}\mu\text{L}$ identify greatest likelihood of exacerbation reduction.

Ensifentrine

An inhaled, first-in-class dual inhibitor of phosphodiesterase-3 (PDE3) and phosphodiesterase-4 (PDE4) with combined bronchodilator and anti-inflammatory properties.

Roflumilast

An oral once-daily phosphodiesterase-4 (PDE4) inhibitor without direct bronchodilator activity, indicated to reduce exacerbations in patients with chronic bronchitis, severe to very severe airflow obstruction ($FEV_1 < 50\%$ predicted), and prior hospitalizations for exacerbation.

Dupilumab

A fully human monoclonal antibody blocking the interleukin-4 receptor alpha ($\text{IL-4R}\alpha$) subunit (inhibiting IL-4 and IL-13 signaling) indicated for patients with COPD, chronic bronchitis, frequent/severe exacerbations on triple therapy, and blood eosinophils $\ge 300\,\text{cells/}\mu\text{L}$.

Mepolizumab

A humanized monoclonal antibody directed against interleukin-5 (IL-5) indicated to prevent exacerbations in COPD patients on triple therapy with blood eosinophils $\ge 300\,\text{cells/}\mu\text{L}$, with or without chronic bronchitis.

Long-Term Oxygen Therapy (LTOT)

Continuous supplemental oxygen therapy ($> 15\,\text{hours/day}$) that improves survival in stable COPD patients with severe chronic resting arterial hypoxemia ($\text{PaO}_2 \le 55\,\text{mmHg}$ or $\text{SaO}_2 \le 88\%$, or $\text{PaO}_2$ $55\text{--}60\,\text{mmHg}$ with cor pulmonale, peripheral edema, or polycythemia).

Endobronchial Valves (EBV)

One-way bronchoscopic prosthetic devices placed in diseased airway lobes of patients with severe hyperinflation and intact interlobar fissures (absence of collateral ventilation) to induce lobar atelectasis and reduce lung volume.

Targeted Lung Denervation (TLD)

A bronchoscopic intervention using radiofrequency energy via a water-cooled catheter to ablate parasympathetic pulmonary nerves along the main bronchi, reducing acetylcholine release, airway smooth muscle tone, and mucus hypersecretion.

Syndemics (COPD)

The clustering and synergistic interaction of two or more co-occurring chronic diseases (e.g., COPD, cardiovascular disease, diabetes) that share biological pathways, social determinants, and common risk factors (such as smoking and aging).

Modified 4Ms Framework

A person-centered clinical approach adapted for multimorbid patients with COPD addressing four core elements: Mentation (depression, anxiety, cognitive status), Mobility (balance, frailty, 6MWD), Medications (polypharmacy, deprescribing, adherence), and Morbidities (organ-system disease clusters).

Multiple Organs Loss of Tissue (MOLT)

A clinical morbidity cluster in patients with COPD characterized by systemic wasting, specifically the co-occurrence of pulmonary emphysema, low body mass index ($BMI < 21\,\text{kg/m}^2$), osteoporosis, and sarcopenia.

Pulmonary Vascular Phenotype of COPD

A severe subgroup of COPD-associated pulmonary hypertension ($\text{PH-COPD}$) characterized by resting mean pulmonary artery pressure ($mPAP > 20\,\text{mmHg}$) and pulmonary vascular resistance ($PVR > 5\,\text{Wood Units}$) alongside mild-to-moderate airflow obstruction, severe reduction in $DL_{CO}$ ($< 45\%$ predicted), and normocapnia.