Summary: The GOLD 2025 Report introduces several important updates compared to the 2024 version, particularly in the field of diagnosis and treatment of chronic obstructive pulmonary disease (COPD). Experts recommend performing spirometry without a post-bronchodilator test to exclude COPD and repeating it with a test to confirm the diagnosis. This approach aims to reduce the rate of false positives and false negatives, thereby helping the patient get help faster. Post-bronchodilator test results that are close to the threshold should be repeated to ensure the correct diagnosis is made. In GOLD 2025, the algorithm for continuing pharmacological treatment was updated to include ensifentrine and dupilumab in the management pathways for shortness of breath and exacerbations. In patients with dyspnea despite LABA/LAMA therapy, it is recommended to consider adding ensifentrine, if available, as an additional treatment. In patients with exacerbations despite the use of corticosteroids/ LAMA/LABA, dupilumab should be considered as an additional treatment in patients with EOS above 300/µl and symptoms of chronic bronchitis.
The Report contains an updated scheme for intensifying therapy in patients using corticosteroids/LABA. Currently, GOLD does not recommend the use of the wGKS/LABA combination. However, the Report clarifies how to escalate patients who are taking this treatment for any reason. The GOLD 2025 Report introduces a new chapter on cardiovascular risk in COPD, highlighting the importance of monitoring and managing this risk in COPD patients. These updates aim to improve the diagnosis and treatment of COPD, taking into account the latest scientific evidence and therapeutic advances.