COPD Through the Lens of Science: The Most Important Questions and Answers for Patients According to the GOLD 2023 Report

This article is entirely based on the latest and most comprehensive scientific report from the GOLD initiative (Global Initiative for Chronic Obstructive Lung Disease), published in 2023 in the prestigious American Journal of Respiratory and Critical Care Medicine. The document was developed by an international team of leading experts in pulmonary diseases and clinical medicine, including Prof. Alvar Agustí (University Hospital Barcelona), Prof. Bartolome Celli (Harvard Medical School, USA), Prof. Gerard Criner (Temple University, USA), Prof. David Halpin (University of Exeter, UK), and more than 15 established scientists and physicians from Europe, North and South America, Asia, and Africa. Their expertise covers both clinical practice and fundamental science, epidemiology, diagnostics, and therapy for COPD. The questions and answers presented below have been selected to provide practical, up-to-date, and science-based information for patients and their families—drawn directly from the published report.

“COPD is a common, preventable, and treatable disease—provided it is recognized and managed in time.”

Why Expert Opinion Matters for COPD Patients

COPD is one of the most serious and widespread health challenges worldwide. Patients and their families often face many questions: How is the diagnosis made? What are the causes and risk factors? How is it treated, and what are the latest approaches? What should be expected during worsening episodes? What is the relationship between COPD and other diseases? In this context, we present five key expert insights and quotes from the authoritative GOLD 2023 report, offering the most current and practical answers for patients, families, and healthcare professionals.

1. What’s New in the Definition of COPD? – Expert View on the Nature of the Disease

“GOLD 2023 defines COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration, and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.”

Explanation: This new definition emphasizes that COPD is a diverse disease that can present with a variety of symptoms and causes, but it always leads to persistent airflow limitation in the lungs.

2. What Are the Main Causes and Risk Factors for COPD? – The Science Behind the Disease

“COPD results from dynamic, cumulative, and repeated gene (G) - environment (E) interactions over the lifetime (T) that damage the lungs and/or alter their normal development/aging processes (GETomics).”

Explanation: COPD is not caused solely by smoking—risk factors also include secondhand smoke, air pollution, occupational exposures, genetic defects, and early-life infections. More than 50% of global cases are due to factors other than cigarettes.

3. How Is the Diagnosis Made? – Expert Algorithm for Patients

“A diagnosis of COPD should be considered in any patient who complains of dyspnea, chronic cough or sputum production, a history of recurrent lower respiratory tract infections, and/or a history of exposure to risk factors for the disease, but forced vital capacity maneuver during spirometry showing the presence of a post-bronchodilator FEV1/FVC ratio < 0.7 is needed to establish the diagnosis of COPD.”

Explanation: Spirometry is essential to confirm the diagnosis. This objective test measures lung volume and airflow speed, helping distinguish COPD from other conditions such as asthma.

4. What Are the Leading Approaches to Treatment? – Updated Therapy Guidelines

“Because inhaled therapy is the cornerstone of COPD treatment, the appropriate use of these devices is crucial to optimize the benefit-risk ratio of any inhaled therapy. … For patients in Group B, a dual long-acting bronchodilator combination (LABA + LAMA) is now recommended since dual therapy is more effective than monotherapy, with similar side effects.”

Explanation: Innovative inhaled therapies are central to treatment—correct usage and patient education are critical for treatment success. In some cases, inhaled corticosteroids are also recommended, especially if frequent exacerbations occur.

5. What Should Be Done During a Flare-Up (Exacerbation)? – Practical Guidelines

“Exacerbations of COPD (ECOPD) negatively affect health status, disease progression, and prognosis. ... GOLD 2023 has adopted the recent consensus Rome proposal, which defines ECOPD as: ‘an event characterized by dyspnea and/or cough and sputum that worsen over <14 days, which may be accompanied by tachypnea and/or tachycardia and is often associated with increased local and systemic inflammation caused by airway infection, pollution, or other insult to the airways.’”

Explanation: If symptoms suddenly worsen (shortness of breath, cough, sputum), immediate medical attention is required. Exacerbations accelerate disease progression and need proper treatment.

Q&A

1. What Does It Mean to Have COPD Along With Other Health Conditions (Comorbidities)? Answer: COPD almost always coexists with other diseases such as cardiovascular disease, diabetes, osteoporosis, depression, and anxiety. These conditions can worsen the overall health status and prognosis. Each comorbidity should be treated according to standard care guidelines, regardless of the presence of COPD. This reduces complications and improves quality of life.

“COPD almost invariably coexists with other diseases (see below) that may significantly affect the patient’s clinical condition and prognosis (162). These comorbid conditions complicate the clinical picture because they can mimic the clinical presentation of COPD, with similar complaints of dyspnea and chest tightness/pain, and lead to misdiagnosis and missed opportunities for treatment. Additionally, comorbid conditions can further limit the pulmonary reserve of patients with COPD.”

2. What Non-Pharmacological (Non-Medication) Therapies Are Recommended for COPD? Answer: Treatment should not rely solely on medication. Patients should receive disease education, training on proper inhaler use, quit smoking, get vaccinated (against flu, pneumococcal disease, COVID-19, etc.), maintain physical activity, and participate in pulmonary rehabilitation programs. These measures have proven benefits for condition management and complication prevention.

“Nonpharmacological treatment is a key part of the comprehensive management of COPD. Education, smoking cessation, vaccination, physical activity, and pulmonary rehabilitation... are beneficial.”

3. What Should I Do If My Symptoms Suddenly Worsen (Exacerbation)? Answer: If symptoms suddenly worsen—like shortness of breath, coughing, or increased sputum—it’s essential to contact a healthcare provider immediately. Depending on severity, an exacerbation may be managed at home or require hospitalization. Timely use of inhaled medications, corticosteroids, and, if needed, antibiotics and oxygen therapy are important. After discharge, a follow-up and support plan should be in place.

“Depending on the episode severity, as well as that of the underlying COPD and comorbidities, an ECOPD can be managed in either the outpatient or inpatient setting... After an exacerbation, it is good practice to cover education on the correct use of the medications and to provide support at home and a follow-up plan before discharge (152).”

4. What Are the Consequences and Prognosis After Hospitalization for a COPD Exacerbation? Answer: The long-term prognosis after hospitalization for a COPD exacerbation is serious—about 50% mortality within five years. Factors that worsen the outlook include older age, low body mass index (BMI), heart disease, previous hospitalizations, severity of the exacerbation, and the need for oxygen therapy at discharge.

“Long-term prognosis after hospitalization for COPD exacerbation is poor, with a five-year mortality rate of about 50% (158). Factors independently associated with poor outcome include older age, lower body mass BMI, comorbidities (e.g., cardiovascular disease or lung cancer), previous hospitalizations for COPD exacerbations, clinical severity of the index exacerbation, and need for long-term oxygen therapy at discharge (159–161).”

5. What Should I Know About the Relationship Between COPD and COVID-19? Answer: COPD patients should follow COVID-19 preventive measures: social distancing, hygiene, vaccination. It is essential to continue taking prescribed inhaled and other medications. If new or worsening respiratory symptoms appear—even mild ones—testing for COVID-19 is necessary. People with COPD are at higher risk of complications and death if infected with the virus.

“COPD patients are not at increased risk of infection with SARS-CoV-2, but this may reflect the effect of protective strategies... After accounting for potential confounding variables, COPD patients do have a higher risk of hospitalization, ICU admission, and mortality (191). COPD patients presenting with new or worsening respiratory or other symptoms that could be COVID-19–related, even if these are mild, should be tested for SARS-CoV-2.”

Conclusion

The data and recommendations presented above are the result of collaborative efforts by leading researchers and clinicians from around the globe, united in their mission to provide the most current knowledge and practical guidance in the fight against COPD. Awareness and timely action are essential for better outcomes and a higher quality of life for every patient. We hope that this overview of key questions and answers will help anyone living with COPD and their loved ones to better understand the diagnosis, treatment options, and daily challenges posed by this impactful condition.

Source: Agustí, A. et al. “Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary.” American Journal of Respiratory and Critical Care Medicine, 2023. Full report: www.goldcopd.org