From the Guidelines
The most recent and reliable information on COPD management comes from the 2023 Canadian Thoracic Society guideline, which recommends LABD maintenance therapy in all symptomatic patients with COPD confirmed by spirometry. As of my last update, news from GOLD 2025 is not available since it would be future information. However, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) regularly updates its guidelines for COPD management, and these updates typically include recommendations on diagnosis, assessment, and treatment strategies, including specific medications like bronchodilators (LABA, LAMA), inhaled corticosteroids, and their combinations 1.
Key Recommendations
- The 2023 Canadian Thoracic Society guideline suggests single inhaler dual therapy LABD in those with moderate to severe dyspnea and/or poor health status, with a step up to single-inhaler triple therapy in those with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy with LAMA/LABA or ICS/LABA 1.
- Given that SITT reduces mortality in individuals with moderate-severe disease and a high risk of AECOPD, the guideline also suggests SITT in all patients at high risk of AECOPD 1.
Clinical Application
For the most current recommendations, healthcare providers should consult the latest published guidelines on the official GOLD website, as these guidelines are based on comprehensive reviews of clinical evidence to optimize COPD management and improve patient outcomes. The organization classifies patients based on symptoms and exacerbation history to guide therapy.
Evidence-Based Practice
In clinical practice, it is crucial to follow the most recent guidelines, such as the 2023 Canadian Thoracic Society guideline, to ensure that patients receive evidence-based care. This approach helps in alleviating symptoms, preventing exacerbations, and reducing mortality in patients with COPD 1.
From the Research
News from GOLD 2025
- The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report is an essential resource for clinicians providing care to patients with chronic obstructive lung disease (COPD) 2.
- The latest updates to the GOLD guidelines include significant advancements in the field of COPD, such as more precise definitions for COPD and its exacerbations, and the introduction of a new set of parameters to measure exacerbation severity 2.
- The report also simplifies the treatment algorithm and sheds light on new findings that suggest the use of pharmacological triple therapy can reduce mortality rates 2.
Treatment Options for COPD
- Long-acting inhaled therapies, including beta-agonists, anticholinergics, and steroids, are preferred over short-acting inhalers for patients with persistent or worsening symptoms of COPD 3.
- Combination therapy with a long-acting beta-agonist (LABA) and an inhaled corticosteroid (ICS) appears to provide an additional benefit over monocomponent therapy, although the extent of this benefit is variable and often not clinically significant in all endpoints assessed 4.
- The use of LABA and ICS in combination has been shown to improve quality of life and lung function in patients with COPD, with a mean improvement in St George's Respiratory Questionnaire (SGRQ) total score and trough forced expiratory volume in one second (FEV1) compared to placebo 3.
Comparison of Treatment Options
- A network meta-analysis comparing four different classes of long-acting inhalers for people with COPD found that combination inhalers (LABA and ICS) improved quality of life and lung function the most, while ICS alone had the least effect 3.
- The addition of LABA to tiotropium resulted in a slightly larger improvement in mean health-related quality of life and pre-bronchodilator FEV1 compared to tiotropium alone, although the differences were small and may not be clinically significant 5.
- Comparing LABA plus tiotropium treatment with LABA alone, there was a small but significant improvement in SGRQ and FEV1, as well as a reduction in exacerbation rates 5.