From the Guidelines
The GOLD 2025 guidelines for COPD management prioritize a personalized approach, focusing on symptom burden and exacerbation risk, with an emphasis on LABD maintenance therapy for all symptomatic patients, as recommended by the 2023 Canadian Thoracic Society guideline 1.
Key Recommendations
- Initial assessment should include spirometry to confirm diagnosis, followed by evaluation of symptoms using validated tools like CAT or mMRC, and assessment of exacerbation history.
- For pharmacotherapy, starting with a long-acting bronchodilator (either LAMA like tiotropium or LABA like salmeterol) is recommended for most patients, with a step up to single-inhaler dual therapy LABD in those with moderate to severe dyspnea and/or poor health status, as suggested by the 2023 Canadian Thoracic Society guideline 1.
- Patients with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy should receive single-inhaler triple therapy, as recommended by the 2023 Canadian Thoracic Society guideline 1.
- For patients at high risk of AECOPD, SITT is suggested, given its proven benefits in reducing mortality, as demonstrated in recent RCTs, including IMPACT and ETHOS 1.
Non-Pharmacological Interventions
- Smoking cessation, pulmonary rehabilitation, vaccination against influenza and pneumococcal disease, and proper inhaler technique education are emphasized as crucial non-pharmacological interventions.
- Oxygen therapy is indicated for patients with severe resting hypoxemia (PaO2 ≤55 mmHg or SaO2 ≤88%).
Treatment Adjustments
- Regular follow-up should assess symptom control, exacerbation frequency, medication adherence, and inhaler technique, with treatment adjustments made accordingly, taking into account the environmental impact and global warming potential associated with metered dose inhalers (MDIs), as discussed in the 2023 Canadian Thoracic Society guideline 1.
From the Research
New Management Guidelines for COPD in GOLD 2025
- The new guidelines for Chronic Obstructive Pulmonary Disease (COPD) management in GOLD 2025 are expected to emphasize the importance of combination therapies, including long-acting beta2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) 2.
- Combination LABA/LAMA therapy has been shown to be effective in improving lung function and reducing exacerbations in patients with COPD 3, 4.
- The choice between LABA/LAMA and LABA/inhaled corticosteroid (ICS) combination therapy should be based on individual patient characteristics, such as symptom control, cost, and adverse event profiles 4.
- LAMAs have been associated with a greater reduction in acute exacerbations and fewer adverse events compared to LABAs in patients with stable COPD 5.
- Different ICS/LABA combinations have varying safety and effectiveness profiles, with some combinations associated with a lower risk of severe pneumonia and acute exacerbation 6.
Key Considerations for COPD Management
- Combination therapy with LABA and LAMA is a recommended treatment option for patients with COPD who are not adequately controlled on monotherapy 2, 3.
- The choice of combination therapy should be individualized based on patient characteristics and medical history 4.
- Regular assessment of lung function, symptoms, and exacerbations is necessary to adjust treatment and optimize patient outcomes 3, 5.
- Patients with COPD should be educated on proper inhaler technique and adherence to treatment regimens to ensure optimal therapeutic outcomes 2, 4.