GOLD 2026 COPD Guidelines: Quick Reference
The bottom line of the GOLD 2026 COPD report: confirm the diagnosis with spirometry, find COPD earlier, treat exacerbation risk sooner (even one moderate exacerbation matters), start most symptomatic patients on a LABA plus LAMA, and aim for stable disease.
At a glance
- Diagnose COPD with a post-bronchodilator FEV1/FVC under 0.70 in a person with symptoms or exposures.
- Look actively for COPD in people who smoke or used to smoke, including through lung cancer screening programs.
- GOLD 2026 treats even one moderate exacerbation before maintenance therapy as a sign of higher future risk.
- Most symptomatic patients start on a long-acting beta-agonist plus a long-acting muscarinic antagonist, ideally in one inhaler.
- Add an inhaled corticosteroid (triple therapy) for exacerbations with raised blood eosinophils; consider dupilumab or mepolizumab in selected patients.
- Every patient: stop smoking, vaccinate (influenza, COVID-19, pneumococcal, RSV), and get pulmonary rehabilitation when symptomatic.
Key recommendations
Diagnosis
Confirm COPD with spirometry: a post-bronchodilator FEV1/FVC under 0.70, read alongside symptoms, exposures and imaging.
Evaluate people who smoke or used to smoke and anyone with unexplained breathlessness, chronic cough or sputum; use lung cancer screening programs to find undiagnosed COPD.
Assessment
Assess symptoms (mMRC or CAT) and exacerbation history to place patients in group A, B or E; GOLD 2026 counts a single moderate exacerbation as a meaningful risk signal.
Use the blood eosinophil count to judge who will benefit from inhaled corticosteroids.
Starting treatment
Start a long-acting bronchodilator in group A, and a LABA plus LAMA (single inhaler preferred) in groups B and E.
Evidence: Evidence AIn group E with blood eosinophils of 300 cells per microliter or more, consider starting triple therapy (LABA plus LAMA plus ICS).
Do not use a LABA plus ICS without a LAMA in COPD; when an ICS is indicated, triple therapy is preferred.
Follow-up
For exacerbations on LABA plus LAMA, step up to triple therapy when eosinophils are 100 cells per microliter or more; otherwise consider roflumilast (FEV1 under 50% with chronic bronchitis) or azithromycin (especially in people who no longer smoke).
In patients who still have exacerbations on triple therapy, consider a biologic: dupilumab or mepolizumab in selected patients with raised eosinophils or chronic bronchitis.
Evidence: Evidence ABefore changing inhalers, check inhaler technique and adherence.
Non-drug care
Help every patient stop smoking, and refer symptomatic patients and those after an exacerbation to pulmonary rehabilitation.
Evidence: Evidence APrescribe long-term oxygen for severe resting hypoxemia (PaO2 of 55 mm Hg or less, or SpO2 of 88% or less).
Evidence: Evidence A
Prevention
Vaccinate against influenza, COVID-19, pneumococcus and RSV, and offer Tdap and zoster vaccines as recommended.
Exacerbations
Treat exacerbations with short-acting bronchodilators, a short course of systemic corticosteroids and, when indicated, antibiotics; use noninvasive ventilation for acute hypercapnic respiratory failure, and follow up soon after discharge.
How to read the grades GOLD
Evidence A: randomized trials with a large, consistent body of data. B: randomized trials with important limitations or a limited body of data. C: nonrandomized trials or observational studies. D: panel consensus where the literature is insufficient.
What changed
Compared with the GOLD 2025 report.
Exacerbation risk
- Before
- Group E needed two or more moderate exacerbations, or one leading to hospitalization, in a year.
- Now
- Criteria adjusted: even one moderate or severe exacerbation before maintenance therapy is treated as a signal of higher risk.
Treatment goal
- Before
- Symptom relief and fewer exacerbations.
- Now
- A new chapter on disease activity, with 'disease stability' and 'disease control' as goals.
Case finding
- Before
- Spirometry for people with symptoms and risk factors.
- Now
- Updated case-finding approach, including lung cancer screening programs.
Vaccines
- Before
- Influenza, COVID-19, pneumococcal, RSV for older adults.
- Now
- Updated RSV and influenza recommendations.
Biologics
- Before
- Dupilumab added for selected patients.
- Now
- Dupilumab and mepolizumab presented with Evidence A in selected populations.
New chapter
- Before
- Not covered.
- Now
- Artificial intelligence and emerging technologies.
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Questions clinicians ask
How is COPD diagnosed under GOLD 2026?
With spirometry: a post-bronchodilator FEV1/FVC under 0.70 in a person with compatible symptoms or exposures. GOLD asks clinicians to read the result alongside the clinical picture and imaging.
What is the first maintenance treatment for most patients?
For patients with high symptoms or exacerbation risk, a long-acting beta-agonist plus a long-acting muscarinic antagonist, ideally in a single inhaler. An inhaled corticosteroid is added for exacerbations with raised blood eosinophils.
When is the next GOLD report?
GOLD publishes a new report every year, usually in November, dated for the following year.
Sources
- Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of COPD: 2026 Report. goldcopd.org/2026-gold-report-and-pocket-guide
- Global Initiative for Chronic Obstructive Lung Disease. Key changes in the GOLD 2026 report. November 10, 2025. goldcopd.org/wp-content/uploads/2025/11/KEY-CHANGES-GOLD-20…
Summarized in our own words by 2 Minute Medicine's physician editors from the source documents listed here. Strength and evidence grades are the guideline authors' own. This is a quick reference, not a substitute for the full guideline or for clinical judgment.
For health care professionals. 2 Minute Medicine is independent and is not affiliated with or endorsed by the societies that write these guidelines.
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