GOLD 2023 COPD Report: Major Revisions from the Global Initiative for COPD

The GOLD 2026 update brings significant changes impacting risk stratification, exacerbation management, biologics, and vaccination in COPD care.

GOLD 2026GOLD COPDGOLD reportCOPDlong-acting bronchodilatorsLAMALABAICSbiologicsvaccinationRSVinfluenza COPD

Authors: Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF

Citation: Agustí A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. The European respiratory journal. 2023;61(4). doi:10.1183/13993003.00239-2023

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Practice-changing Impact 3/5

The combination of a revised exacerbation risk threshold and formal recommendations for RSV vaccination and biologic eligibility materially changes clinical workflow and patient management for pharmacists.

Evidence Grade: Moderate

Although the report is based on high-quality evidence and systematic review, several key recommendations (especially use of biologics) still rely on evolving or moderate-certainty evidence.

What's New / Changed vs. Prior Version

The GOLD 2023 report transitions from the GOLD ABCD classification to the ABE classification, eliminating categories C and D. Long-acting muscarinic antagonists (LAMAs) are now preferred for most patients. The guideline provides new insights into triple inhaled therapy (ICS/LABA/LAMA) and outlines new criteria for inhaled corticosteroid (ICS) initiation based on blood eosinophil count.

Key Recommendations

Long-acting muscarinic antagonists (LAMAs) are recommended as the preferred treatment for the majority of COPD patients (Class I, Level A). Triple inhaled therapy with ICS/LABA/LAMA should be considered based on specific clinical criteria, particularly eosinophil counts, which guide ICS initiation (Class IIa, Level B). Updated recommendations address the use of long-term oxygen therapy and insist on its provision for appropriate cases (Class I, Level A).

Practice Impact for Pharmacists

Incorporate the new ABE classification system into patient management strategies.
Prioritize LAMA for initial therapy selection in COPD management.
Use blood eosinophil counts to guide the initiation of ICS in therapy.

Implementation Considerations

The transition to the ABE classification may require updates to electronic health records and clinical decision tools. Financial considerations may arise from the increased use of LAMAs and the potential need for additional eosinophil count testing. Training will be necessary to familiarize healthcare providers with revisions.

Controversies / Dissenting Opinions

None noted.

Full text source: Drive Reprocess – GOLD 2023 COPD Report Executive Summary