The Global Initiative for Chronic Obstructive Lung Disease 2025 Report outlined key updates on the diagnosis, management, and prevention of chronic obstructive pulmonary disease.
The report addressed the rising burden of chronic obstructive pulmonary disease (COPD), anticipated to affect nearly 600 million patients by 2050. Physicians were advised to consider COPD among the top three global causes of mortality, with prevalence projected to increase as a result of aging populations and smoking rates, especially in low- and middle-income countries. More than 3 million deaths were attributed annually to COPD, with a notable impact on disability-adjusted life-years (DALYs) in low- and middle-income regions.
The report included comprehensive data on COPD's financial toll, estimating costs of respiratory diseases in the European Union at approximately €38.6 billion annually, 56% of which was attributed to COPD. In the United States, costs related to COPD were projected to reach $800 billion by 2040. COPD’s economic burden was compounded in low-income regions where the accessibility of inhaled medicines and diagnostic spirometry remained limited. In these regions, approximately 50% of COPD cases were caused by nonsmoking factors such as biomass exposure and occupational inhalants.
In the report, COPD was defined as a condition with chronic respiratory symptoms (dyspnea, cough, sputum production, and exacerbations) stemming from airflow obstruction. The report advised clinicians to confirm diagnoses based on postbronchodilator FEV1/FVC ratios below 0.7. GOLD introduced additional phenotypes—Pre-COPD and PRISm (Preserved Ratio Impaired Spirometry)—to describe individuals with symptoms and lung abnormalities who did not yet meet criteria for airflow obstruction. These patients were observed to be at elevated risk of progression and were recommended for closer monitoring.
Two new therapies, ensifentrine and dupilumab, were incorporated into the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2025 recommendations for treating COPD. Ensifentrine, a phosphodiesterase-4 (PDE4) inhibitor with anti-inflammatory and bronchodilator effects, was included across several treatment pathways, including maintenance medications. Dupilumab was recommended among patients with eosinophilic phenotypes, potentially reducing exacerbation frequency. The report emphasized these drugs’ placement within the broader pharmacologic treatment algorithm, advising their use based on specific phenotypic markers.
Spirometry remained central to COPD diagnosis, with GOLD updating lower limit of normal (LLN) values and offering enhanced guidance on reference scores for increased diagnostic precision. GOLD also incorporated cardiovascular risk assessments, recognizing that patients with COPD often faced elevated cardiovascular morbidity. Imaging was recommended to identify conditions such as emphysema, nodules, and air trapping, further aiding in patient assessment.
The GOLD 2025 report followed CDC guidelines, recommending vaccines, including influenza, pneumococcal, and respiratory syncytial virus (RSV) vaccines in patients with stable COPD to reduce risks associated with exacerbations. GOLD also advised that physicians consider environmental factors like air pollution and occupational hazards in COPD prevention, estimating that 50% of cases worldwide were related to nonsmoking risks.