COPD Today: The Scientific Answers That Save Lives – Insights from the GOLD 2023 Report

 This material is based on the latest and most comprehensive scientific consensus report from the Global Initiative for Chronic Obstructive Lung Disease (GOLD): “Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary” (American Journal of Respiratory and Critical Care Medicine, Vol 207, Issue 7, 2023). The document was prepared by an international team of leading pulmonologists, medical researchers, and clinicians, including: Prof. Alvar Agustí (University Hospital Barcelona), Prof. Bartolome Celli (Harvard Medical School), Prof. Gerard Criner (Temple University), Prof. MeiLan Han (University of Michigan), Prof. Fernando Martinez (Weill Cornell Medical Center), along with many other established specialists from Europe, the United States, Canada, Latin America, Asia, and Africa.

The report presents the most up-to-date information, supported by more than 380 scientific sources, and serves as the global gold standard for understanding, diagnosing, treating, and preventing COPD. In the following sections, you’ll find selected questions and answers specifically designed to address the needs of patients—entirely based on this authoritative source.

“COPD is not just a smoker’s disease – air pollution, occupational hazards, and early-life factors are just as important causes. Timely diagnosis and active treatment can change the course of the disease for every patient.”

Expert Opinions on COPD

COPD is one of the most significant chronic lung diseases, affecting millions of people worldwide. It requires a comprehensive approach to both diagnosis and treatment. Science and clinical practice are constantly advancing our understanding of its causes, progression, therapy, and prevention. In this context, the following selection of expert opinions and quotes from leading doctors and researchers (authors of the GOLD 2023 global COPD report) is provided to deliver the most current and evidence-based information to support patients, their families, and healthcare providers in daily practice and informed decision-making.

1. What’s New in the Definition and Understanding of COPD According to GOLD 2023?

Expert Opinion: “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 means COPD presents with diverse symptoms and causes—it’s not limited to smokers. It involves various changes in the bronchi and alveoli. It’s important for patients to recognize early symptoms such as shortness of breath, coughing, or phlegm production, as early detection is key to timely diagnosis.

2. What Are the Main Risk Factors for Developing COPD?

Expert Opinion: “Cigarette smoking is a key environmental risk factor for COPD... yet fewer than 50% of heavy smokers develop COPD. In low- and middle-income countries, COPD in nonsmokers may be responsible for up to 60–70% of cases... Wood, animal dung, crop residues, and coal (i.e., biomass), typically burned in poorly functioning stoves, may lead to very high levels of household air pollution, which is associated with increased COPD risk...”

Explanation: Smoking remains the leading risk factor, but nearly half of all people with COPD have never smoked. In many countries, household air pollution (from wood, coal, and other biomass) and occupational exposures are also major contributors. That means anyone with chronic respiratory symptoms should be evaluated, regardless of smoking history.

3. How Is COPD Diagnosed, and What Are the Warning Signs?

Expert Opinion: “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... 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 the key diagnostic tool. If you have chronic shortness of breath, coughing, or phlegm, especially with risk factors, you should request a spirometry test. Early diagnosis is essential for effective treatment.

4. What Are the Core Principles in the Modern Treatment and Monitoring of COPD?

Expert Opinion: “Pharmacological therapy must always be associated with nonpharmacological measures described later, starting with smoking cessation when needed... the appropriate use of inhaler devices is crucial... Regular assessment at follow-up is necessary to maintain their effective use... For patients with persistent dyspnea or exercise limitation on bronchodilator monotherapy, a step up to LABA+LAMA is recommended... All patients should receive basic information about COPD and its treatment (respiratory medications and inhalation devices), strategies to minimize dyspnea, and advice about when to seek help.”

Explanation: Treatment is personalized and combines medications with non-drug interventions—smoking cessation, rehabilitation, vaccination, proper inhaler use education, and regular follow-ups are all essential.

5. What Are the Most Common Comorbidities, and Why Is It Important to Pay Attention to Them?

Expert Opinion: “COPD almost invariably coexists with other diseases that may significantly affect the patient’s clinical condition and prognosis. 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... In general, the presence of comorbidities should not alter COPD treatment and comorbidities should be treated per usual standards regardless of the presence of COPD.”

Explanation: COPD often coexists with heart disease, diabetes, osteoporosis, anxiety, depression, and more. Proper treatment of all conditions improves patient outcomes and quality of life. Mental health symptoms should not be overlooked—they are common and often go unrecognized.

Q&A

1. Can I Get COPD Even If I’ve Never Smoked?

Yes, absolutely. In some countries—especially in developing regions—up to 60–70% of COPD cases occur in people who have never smoked. Contributing factors include exposure to smoke from burning wood, coal, animal dung, and other biomass in the household, occupational pollutants, and chronic exposure to air pollution. That means chronic cough or shortness of breath should not be ignored even in non-smokers.

2. What Symptoms Should Prompt Me to Get Checked for COPD?

The main symptoms are:

• Chronic shortness of breath (especially during physical activity)

• Persistent cough, which may be dry or with mucus

• Frequent respiratory infections

• Chronic fatigue and reduced physical stamina

These symptoms should not be underestimated, especially if you have risk factors such as smoking, air pollution exposure, working in dusty or polluted environments, or chronic respiratory infections in childhood.

3. How Important Is Spirometry, and Why Should It Be Repeated If Results Are Borderline?

Spirometry is essential for diagnosing COPD. If the FEV1/FVC ratio is between 0.60 and 0.80 on the first test, a repeat test on another day is recommended, as results can vary for biological reasons. Only when the ratio is below 0.60 is it highly unlikely to normalize spontaneously. Repeating the test helps avoid misdiagnosis or missing early disease.

4. Does Early Detection Matter, and Can COPD Progression Be Slowed?

Early detection is crucial. COPD can begin early in life (even in childhood, with risk factors like premature birth, malnutrition, passive smoking, etc.) and remain unrecognized for years. Timely diagnosis enables interventions such as quitting smoking, reducing harmful exposures, rehabilitation, and starting appropriate treatment. These actions have been proven to slow lung function decline and improve quality of life.

5. What Other Conditions Might I Have Alongside COPD, and How Do They Affect My Health?

COPD almost always coexists with other illnesses, known as comorbidities. The most common include cardiovascular disease, diabetes, osteoporosis, gastroesophageal reflux, anxiety and depression, anemia, and more. These conditions can worsen COPD symptoms, complicate diagnosis, and influence treatment choices and outcomes. Each illness should be treated according to standard medical guidelines, without neglecting COPD—or vice versa.

Conclusion 

The information summarized above is intended to provide patients and their families with a clear, evidence-based overview of current understanding, diagnosis, prevention, and treatment of COPD, as well as the crucial role of associated health conditions. All answers are drawn directly from the GOLD publication, where the expertise of leading specialists is combined with up-to-date evidence and clinical guidance, always with the patient in mind. This approach ensures that the information reflects the world’s best practices and supports informed decisions, prevention, and improved quality of life for those living with COPD.

Source Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Prevention, Diagnosis and Management of COPD: 2023 Report. GOLD Executive Summary (Alvar Agustí et al.), American Journal of Respiratory and Critical Care Medicine, Vol 207, Issue 7, pp. 819–837, 2023. https://goldcopd.org/2023-gold-report-2/