The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report is an essential resource for healthcare professionals (HCPs) involved in the diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease (COPD). The 2025 update introduces significant changes aimed at enhancing patient outcomes through refined diagnostic criteria and treatment strategies. This article delves into these key changes, emphasizing their impact on HCP approaches to screening and managing patients with COPD.
Overview of GOLD COPD Report: 2025 update
The GOLD report, a comprehensive guide developed by the GOLD Science Committee, provides a non-biased review of current evidence for the assessment, diagnosis, and treatment of COPD. The GOLD report is revised on an annual basis with the primary objective of aiding clinicians in delivering the best possible care to patients with COPD.1 The 2025 update continues this tradition by incorporating the latest research findings and clinical practices to improve patient outcomes.
The 2025 GOLD report introduces several noteworthy changes in the diagnosis and treatment of COPD.1&nbsp;The following key sections were revised:

<h2>1. Updated spirometry section</h2>
A new flowchart elaborating on the role of pre- and post-bronchodilator spirometry for the assessment of airflow obstruction and diagnosis of COPD has been included in the spirometry section. For diagnosis of COPD, a forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio of &lt;0·7 on post-bronchodilator spirometry still remains mandatory. Consistent with the 2024 GOLD report,2&nbsp;it is not recommended to measure FEV1 before and after bronchodilators or corticosteroids for assessing degree of reversibility and guiding therapeutic decisions.

<h2 style="margin-top: 16px;">Updated follow-up pharmacological management strategies</h2>
The “Algorithms for follow-up pharmacological management” section has been updated to include new treatment options for patients with dyspnea and persistent exacerbations and provide clear guidance on management of patients currently on long-acting beta-adrenoreceptor agonist (LABA) + inhaled corticosteroid (ICS).
Dyspnea
If addition of a second long-acting bronchodilator does not improve symptoms in patients with persistent breathlessness or exercise limitation on bronchodilator&nbsp;monotherapy, the 2024 GOLD report recommended considering switching inhaler device or pharmacotherapy. The 2025 GOLD report additionally recommends the following:
<ul>
 <li>Implementing or escalating non-pharmacological treatment(s) e.g., pulmonary rehabilitation</li>
 <li>Considering adding ensifentrine, if available</li>
</ul>
Persistent exacerbations
In patients treated with LABA + long-acting muscarinic antagonist (LAMA) and blood&nbsp;eosinophil count (EOS) &lt;100 cells/µL who still have exacerbations, the following treatment is recommended1:
<ul>
 <li style="margin-top: 8px; margin-bottom: 8px;">Among those who are not currently smoking, consider adding azithromycin. Consideration to the development of resistant organisms should be factored into decision making</li>
 <li style="margin-top: 8px; margin-bottom: 8px;">Among those with FEV1 &lt;50%, symptoms of chronic bronchitis and history of prior severe exacerbation, consider adding roflumilast</li>
</ul>
In patients treated with LABA+LAMA+ICS (or those with EOS &lt;100 cells/µL) who still have exacerbations, the following treatment is recommended1:
<ul>
 <li>Among those who are not currently smoking, consider adding azithromycin. Consideration to the development of resistant organisms should be factored into decision making</li>
 <li>Among those with FEV1 &lt;50%, symptoms of chronic bronchitis and history of prior severe exacerbation, consider adding roflumilast</li>
 <li>Among those with EOS ≥300 cells/µL and symptoms of chronic bronchitis, consider adding dupilumab</li>
</ul>

To learn about the stability and predictive value of blood EOS in COPD, please click <a href="https://pro.campus.sanofi/copd/articles/a-review-of-the-clinical-implications-of-eosinophil-stability-and-predictive-capability-in-copd" style="color:#0563c1; text-decoration:underline">here</a>.
Management of patients currently on LABA+ICS
Generally, if there is an indication for ICS use then LABA+LAMA+ICS has been shown to be superior to LABA+ICS. For patients on LABA+ICS with major symptoms, the 2024 report recommended considering a switch to LABA+LAMA.2&nbsp;The 2025 report recommends changing to LABA+LAMA or LABA+LAMA+ICS while considering previous response to ICS treatment. 
The benefits and risks of ICS withdrawal should be carefully considered, with a blood EOS count &gt;300 cells/µL being an indicator of increased risk of exacerbations with ICS withdrawal.1&nbsp;Additionally, the updated 2025 report emphasizes that the ICS component should not be withdrawn in patients treated with LABA+LAMA+ICS unless the ICS were started inappropriately or there has been no response to ICS, or patients experience significant side-effects or severe or recurrent pneumonia.1
Furthermore, it is important to review whether there was a relevant prior exacerbation history or a previous positive response to LABA+ICS treatment. A history of exacerbations but absence of current exacerbations suggests a positive response to treatment.1

<h2>2. Introduction of new pharmacotherapies</h2>
The 2025 report included two new drugs in the list of pharmacotherapies, a phosphodiesterase 3 and 4 (PDE 3 and PDE 4) inhibitor and a biologic that blocks the shared receptor component of IL-4 and IL-13.
Phosphodiesterase 3 and 4 (PDE 3 and PDE 4) inhibitor
The PDE 3 and PDE 4 inhibitor, delivered via nebulizer, is now included as a maintenance medication and bronchodilator for stable COPD. It is known to&nbsp;significantly improve lung function (Evidence A), dyspnea (Evidence A) and health status (Evidence B).1&nbsp;The drug has shown significant improvement in lung function and dyspnea with no safety or tolerability issues,3 in parallel phase 3 studies.4
Drugs with potential to reduce exacerbations 
This section has added evidence to support the efficacy of the biologic therapy, a fully human monoclonal antibody that blocks the shared receptor component of IL-4 and IL-13. The biologic was evaluated in a study population comprising COPD patients with symptoms of chronic bronchitis, a history of ≥2 moderate exacerbations or ≥1 severe exacerbation(s) in the previous year despite treatment with LABA+LAMA+ICS, and blood EOS count ≥300 cells/µL.1 Patients receiving this biologic demonstrated fewer exacerbations, better lung function and improved symptoms over 52 weeks in two large, double-blind, randomized phase 3 studies.5,6
Summary of the key Updates and Why They Matter
The changes introduced in the 2025 GOLD report aim to enhance the accuracy of diagnosis of COPD and latest treatment strategies. By refining the sections on spirometry, follow-up pharmacological treatment, management of patients and reflecting on the latest evidence on newly recommended biologic therapy with the potential to reduce exacerbations, the report provides a comprehensive framework for improving patient outcomes.
The revised follow-up pharmacological management strategies suggested escalation and de-escalation based on available efficacy and safety data.1 For healthcare professionals, these changes along with the revised algorithms for pharmacological treatment means adopting a more evidence-based and personalized approach to COPD management. 
Know more about the role of <a href="https://pro.campus.sanofi/copd/articles/blood-eosinophils-as-a-biomarker-in-patients-with-copd" style="color:#0563c1; text-decoration:underline">Blood Eosinophils as a Biomarker in Patients with COPD</a>
In conclusion, the 2025 GOLD report represents a significant step forward in the diagnosis and management of COPD. By staying informed about these changes and incorporating them into clinical practice, healthcare professionals can continue to provide the highest standard of care to their patients.
Click here to refer to the <a href="https://goldcopd.org/2025-gold-report/" style="color:#0563c1; text-decoration:underline">GOLD 2025</a> report for more information.

The GOLD guidelines provide evidence-based strategies for the diagnosis and management of COPD. The GOLD 2025 update has refined the sections on diagnosis and management of COPD and reflects on the latest evidence on newly recommended therapies.

Understanding the Changes in the GOLD Report from 2024 to 2025

CHRONIC-OBSTRUCTIVE-PULMONARY-DISEASE-(COPD)

COPD is a heterogenous and progressive disease, driven by distinct chronic immune processes. In a round table discussion, leading respiratory experts discussed 
<ol style="margin-top:8px; margin-bottom:11px">
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-current-unmet-needs-for-patients-with-copd" style="color:#0563c1; text-decoration:underline">What are the current unmet needs for patients with COPD?</a></li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-different-inflammatory-pathways-in-copd-impacting-disease-pathobiology-and-progression" style="color:#0563c1; text-decoration:underline">How do different inflammatory pathways in COPD impact disease pathobiology and progression?</a></li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px">Biomarkers to guide COPD management. </li>
</ol>
&nbsp;
The round table was chaired by Professor Paola Rogliani of the University of Rome, Italy. Other respiratory experts on the panel were:
Dr. MeiLan Han, Professor of pulmonary critical care medicine at the University of Michigan, Ann Arbor, MI, USA.
Dr. Marc Miravitlles, a chest physician from the Hospital Universitari Vall d’Hebron, Barcelona, Spain.
<h2 style="margin-bottom: 11px;">Biomarkers to guide COPD management</h2>
Check out the video below to gain valuable insights on this topic from the respiratory experts

The article "Biomarkers to guide COPD management" features insights from a round table discussion involving leading respiratory experts. It focuses on chronic obstructive pulmonary disease (COPD), a heterogeneous and progressive condition. The experts discuss the risk factors for frequent exacerbation, use of blood eosinophil count (EOS) as a biomarker in COPD, and the association of EOS with type 2 inflammation.

A video series on round table discussions featuring experts: Biomarkers to guide COPD management

In this video, Dr. Miravitlles discusses the biomarkers to guide COPD management, followed by a panel discussion with other experts.
<h3 style="margin-top: 8px; margin-bottom: 11px;">Risk factors for frequent exacerbation</h3>
Dr. Miravitlles started his talk by highlighting that patients with frequent exacerbations are the most challenging and also those having the worst prognosis. Therefore, one of the aims of therapy in COPD is to prevent exacerbations. He explained that to understand the frequent exacerbator phenotype, we need to know the characteristics of these patients. “It is not restricted to very severe patients,” he added. 
Patients who have a history of frequent exacerbations are those likely to suffer frequent exacerbations in the future. 
Other risk factors for frequent exacerbations include:1

Dr. Miravitlles highlighted that the characteristics to identify the frequent exacerbator phenotype in COPD and those requiring more intensive treatment are patients who had more frequent exacerbations or severe exacerbations that resulted in hospital admission, in the past. Furthermore, patients with frequent exacerbations exhibit different mechanisms for exacerbations and are required to be treated differently.

<h3 style="margin-top: 8px; margin-bottom: 11px;">Blood eosinophil count (EOS) as a biomarker in COPD: GOLD scientific committee findings</h3>
Dr. Miravitlles emphasized that there is a need for biomarkers in COPD to guide the practicing clinicians about the first choice of treatment for each type of exacerbation. He further added, “Blood eosinophils (EOS) are a good biomarker to identify COPD patients with a predominant type 2 inflammation.” 
Read more about <a href="https://pro.campus.sanofi/copd/articles/blood-eosinophils-as-a-biomarker-in-patients-with-copd" style="color:#0563c1; text-decoration:underline">blood eosinophils as a biomarker in patients with COPD</a>
<h4 style="margin-top: 8px; margin-bottom: 11px;">Prediction of benefits from inhaled corticosteroids (ICS)</h4>
Blood eosinophil count (BEC [EOS]) should be combined with exacerbation history to predict ICS effects.3 Dr. Miravitlles explained that there are several clinical trials which have demonstrated the use of BEC (EOS) to predict the effects of ICS in preventing exacerbations, particularly when combined with exacerbation history. However, relationship between BEC (EOS) and ICS effects is continuous,3 and there is no clear threshold for BEC (EOS). Thresholds of &lt;100 cells/μL and ≥300 cells/μL help to identify individuals with the lowest and greatest, respectively, likelihood of ICS benefit.3 
Dr. Miravitlles cautioned that if BEC (EOS) is &lt;100 cells/µL, there is almost no effect of ICS and their long-term use can result in more side effects. “In contrast, patients with BEC (EOS) ≥300 cells/µL respond very well to ICS and have a significant reduction in the risk of exacerbations”, he added.

<h4 style="margin-bottom: 11px;">Type 2 inflammation</h4>
Dr. Miravitlles emphasized, “It is clear that there is some relationship between BEC (EOS) and markers of type 2 inflammation.” He further highlighted that the relationship is not perfect, but the relationship between BEC (EOS) and eosinophils in the lower airways is significant.

Learn more about type inflammation in COPD from <a href="https://pro.campus.sanofi/copd/articles/decoding-type-2-inflammation-in-copd-an-expert-perspective" style="color:#0563c1; text-decoration:underline">decoding type 2 inflammation in COPD: An expert’s perspective</a>
<h4 style="margin-bottom: 11px;">Future risk of exacerbations/disease progression</h4>
In younger individuals without COPD, higher BEC (EOS) are associated with increased risk of decline of forced expiratory volume in 1 second and development of COPD.3 “So, it is an important biomarker to identify these risks in a wider population”, Dr. Miravitlles pointed out.
BEC (EOS) cannot be used as a standalone biomarker of future risk without considering exacerbation risk and ICS use.3
Dr. Miravitlles summarized his discussion by saying, “We have an easy-to-use biomarker to identify a particular subgroup of patients who are more likely to respond to some types of drugs, such as ICS and this biomarker can be accessed at all levels of healthcare, even in primary care.” 
<h3 style="margin-bottom: 11px;">Panel discussion</h3>
Dr. Miravitlles’s presentation was followed by individual perspectives of the panel of experts on biomarkers to guide COPD management.
Dr. Rogliani opened the panel discussion by highlighting the need for more biomarkers in the future to characterize patients with chronic obstructive diseases. She further added that BEC (EOS) is easy to use and easy to detect, but we will need a more precise way to detect it, which is still confined to research settings. 
She concluded by saying, “BEC (EOS) is a useful biomarker, and it is helpful to manage patients in daily practice in our daily routine.”
Dr. Han emphasized that the cut offs for BEC (EOS) of 300 cells/µL for initial use of triple therapy and 100 cells/µL for escalating therapy in patients who are continuing to exacerbate on current therapy, provided in the GOLD document are sort of guideposts. She thought that the data for eosinophil-guided ICS, specifically for eosinophils &lt;100 cells/µL was on the weaker side, whereas benefits appear stronger as the eosinophil levels go higher. 
She stated, “In an ideal world we would be using sputum eosinophils, but that’s a challenging biomarker to get outside of our research setting.” “There is a potential for other biomarkers in the future,” she further pointed out.
Dr. Miravitlles added his thoughts, “BEC (EOS) is not a perfect biomarker, but is good enough to be used in clinical practice.” He further emphasized that with the evidence available at present, it is good enough in clinical practice for specialists and general practitioners.

The article "Biomarkers to guide COPD management" features insights from a round table discussion involving leading respiratory experts. It focuses on chronic obstructive pulmonary disease (COPD), a heterogeneous and progressive condition. The experts discuss the risk factors for frequent exacerbation, use of blood eosinophil count (EOS) as a biomarker in COPD, and the association of EOS with type 2 inflammation.

COPD is a heterogenous and progressive disease, driven by distinct chronic immune processes. In a round table discussion, leading respiratory experts discussed 
<ol style="margin-top:8px; margin-bottom:11px">
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-current-unmet-needs-for-patients-with-copd" style="color:#0563c1; text-decoration:underline">What are the current unmet needs for patients with COPD?</a></li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px">How do different inflammatory pathways in COPD impact disease pathobiology and progression?</li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-biomarkers-to-guide-copd-management">Biomarkers to guide COPD management. </a></li>
</ol>
&nbsp;
The round table was chaired by Professor Paola Rogliani of the University of Rome, Italy. Other experts on the panel were:
Dr. MeiLan Han, Professor of Pulmonary Critical Care Medicine at the University of Michigan, Ann Arbor, MI, USA.
Dr. Marc Miravitlles, a chest physician from the Hospital Universitari Vall d’Hebron, Barcelona, Spain.
<h2 style="margin-bottom: 8px;">How do different inflammatory pathways in COPD impact disease pathobiology and progression?</h2>
Watch the video below to gain insights on this topic from the respiratory experts.

The article "How do different inflammatory pathways in COPD impact disease pathobiology and progression?" features insights from a round table discussion involving leading respiratory experts. It focuses on chronic obstructive pulmonary disease (COPD), a heterogeneous and progressive condition. The experts delved into the inflammatory processes in COPD, particularly type 2 pathway and its associated endotype, emphasizing the importance of identifying patients by endotypes.

A video series on round table discussions featuring experts: Different inflammatory pathways in COPD impacting disease pathobiology and progression

In this video, Dr. Han provides answers to a pertinent question from Prof. Rogliani, “How do different inflammatory endotypes of COPD impact disease pathogenesis and progression?”
<h3 style="margin-bottom: 8px;">COPD is a heterogenous disease</h3>
COPD is the end-result of complex, cumulative and dynamic gene-environment interactions over the lifetime that can damage the lungs and/or alter their normal developmental or aging processes.1
<h3 class="Default" style="margin-bottom: 8px;">Inflammatory processes in COPD</h3>
Dr. Han remarked that traditionally, it is believed that COPD is driven by neutrophilic inflammation. COPD is typically associated with increased macrophages in peripheral airways, lung parenchyma and pulmonary vessels, along with activated neutrophils and lymphocytes.1 Neutrophils stimulate mucus hypersecretion and generate further oxidative stress, which can perpetuate inflammation.2
Airway damage following exposure to cigarette smoke and pollutants leads to an&nbsp;epithelial alarmins-mediated pro-inflammatory cascade, involving key cytokines such as IL-33, IL-25 and thymic stromal lymphopoietin (TSLP).3 Altered barrier function resulting from airway damage also predisposes the airway to infection, further amplifying the type 1 inflammatory cascade.3

<h3>Type 2 pathway in COPD</h3>
Dr. Han highlighted, “In recent years, we've begun to better appreciate another inflammatory pathway that can be important in some patients with COPD, which is type 2 inflammation.”
Listen to an expert’s perspective on <a href="https://pro.campus.sanofi/copd/articles/decoding-type-2-inflammation-in-copd-an-expert-perspective" style="color:#0563c1; text-decoration:underline">Decoding Type 2 Inflammation in COPD</a>
Type 2 inflammation in COPD encompasses type 2 effector cells, including type 2 helper cells (Th2), innate lymphoid cells (ILC2), eosinophils and mast cells, as well as key cytokines such as IL-4, IL-5, and IL-13.4,5

Learn more about the <a href="https://pro.campus.sanofi/copd/articles/role-of-type-2-inflammation" style="color:#0563c1; text-decoration:underline">Role of Type 2 Inflammation</a>
<h3>COPD endotype with type 2 inflammation</h3>
A subset of patients with COPD and type 2 airway inflammation has been identified, even after excluding features of asthma.4,8 The prevalence of persistently elevated blood eosinophil count (BEC [EOS]) varies between studies, depending on population characteristics and threshold definitions used for evaluation.4
Read more about <a href="https://pro.campus.sanofi/copd/articles/blood-eosinophils-as-a-biomarker-in-patients-with-copd" style="color:#0563c1; text-decoration:underline">Blood Eosinophils as a Biomarker in Patients with COPD</a>
In this context, Dr. Han discussed the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) cohort study, which demonstrated that 37% of patients with COPD (n=554/1483) had persistently elevated BEC (EOS) (≥2%).8

Referring to two studies in frequent exacerbators receiving triple therapy for COPD, Dr. Han pointed out that, “BEC (EOS) can be seen elevated in patients with frequent exacerbations.”

She also emphasized, “So this is actually an incredibly common finding in COPD.”
<h3>Panel discussion</h3>
Following Dr. Han’s presentation, the panel of experts put forth their opinions on the involvement of type 2 inflammation in COPD pathogenesis.&nbsp;
Dr. Rogliani pointed out that endotyping is a key to properly understanding the&nbsp;disease and how to eventually treat COPD patients.
She added that airway epithelium is the key aspect in determining the type of&nbsp;inflammatory profile a patient can exhibit because it will respond differently upon&nbsp;exposure to different stimuli such as pollution/smoking/infection, infection and&nbsp;smoking. “This will lead to a different cascade of inflammatory mediators, cytokines&nbsp;and also on cellular level such as eosinophils”, Dr. Rogliani further highlighted.
Dr. Miravitlles pointed out that the possibility of availability of biomarkers that can&nbsp;easily be used by all practicing physicians — not only specialists, but also in primary&nbsp;care — to identify patients with different endotypes, can help to move from bench to&nbsp;bedside (i.e. to move from the research arena to the clinical practice).&nbsp;
For more information, please read <a href="https://pro.campus.sanofi/copd/articles/a-review-of-the-clinical-implications-of-eosinophil-stability-and-predictive-capability-in-copd" style="color:#0563c1; text-decoration:underline">A review of the clinical implications of eosinophil stability and predictive capability in COPD</a>
Dr. Rogliani agreed that it could be a good start to characterize the patient&nbsp;differently from the standpoint of inflammatory profile.
Dr. Han added that blood eosinophils are there for clinicians right now. She&nbsp;highlighted that patients really benefit clinically from steroids, but it is terrible that&nbsp;chronic use of steroids is associated with long term harms. Further, she added,&nbsp;“There is subset of patients which does have type 2 inflammation. We need to find&nbsp;better ways of identifying such patients because they really would benefit from&nbsp;targeted therapies.”
Dr. Rogliani concluded this topic by saying, “Identification of the right patient is the&nbsp;key in order to better treat and better approach COPD patients.”

The article "How do different inflammatory pathways in COPD impact disease pathobiology and progression?" features insights from a round table discussion involving leading respiratory experts. It focuses on chronic obstructive pulmonary disease (COPD), a heterogeneous and progressive condition. The experts delved into the inflammatory processes in COPD, particularly type 2 pathway and its associated endotype, emphasizing the importance of identifying patients by endotypes.

What if you could identify higher-risk patients?&nbsp;&nbsp;
A deeper look at the inflammation behind exacerbations could ignite new thinking in COPD. Look for blood eosinophils, a biomarker of COPD with Type 2 Inflammation, which may help you identify those patients at increased risk of exacerbations.
Watch the video below to better understand exacerbations in COPD and better identify patients at risk.&nbsp;&nbsp;&nbsp;

Understanding type 2 inflammation may help shed light on why some patients continue to exacerbate. Watch this video to learn how.

One minute to ignite new thinking in COPD

Ignite new thinking in COPD -&nbsp;COPD, chronic obstructive pulmonary disease
In patients with COPD, exacerbations may :&nbsp;
<ul>
 <li>Increase the risk of another&nbsp;1</li>
 <li>Accelerate lung function decline&nbsp;2</li>
 <li>Increase morbidity and mortality risk&nbsp;1,3-6</li>
</ul>
Different types of chronic inflammation have an important role in COPD&nbsp;7-15 
 Type 2 inflammation and beyond type 2 inflammation 
 Identifying COPD patients with type 2 inflammation may help determine those at increased risk of exacerbations 16 
 Look for blood eosinophils, a biomarker of COPD with type 2 inflammation 17,18, a, b 
 EOS ≥ 300 cells/ μL à 32% increased risk of COPD exacerbations 16a,b 
 Understanding type 2 inflammation in COPD may shed light on why some patients continue to experience exacerbations
a Results from an observational analysis of 1553 patients with GOLD spirometry grade 2-4 COPD evaluating the relationship between blood eosinophil count and COPD exacerbation risk. b Stratified analysis confirmed that increased exacerbation risk was driven by subjects with a history of frequent exacerbations, defined as ≥2 exacerbations per year.

Read video transcript

Understanding type 2 inflammation may help shed light on why some patients continue to exacerbate. Watch this video to learn how.

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