Pharmacy Pearl: GOLD Guidelines for Optimizing COPD Treatment

By: Alba Dona, PharmD Candidate c/o 2027

Chronic obstructive pulmonary disease (COPD) is a disease caused by damage to the airways or other parts of the lung. The most common forms are emphysema and chronic bronchitis. The damage can lead to inflammation and make it harder to breathe.¹ The most common symptoms of COPD are difficulty breathing, chronic cough, wheezing, shortness of breath, and excess phlegm. COPD is a progressive disease that is often caused by a combination of factors, such as tobacco exposure from active smoking or secondhand smoke, childhood asthma, occupational exposure to chemicals, and family history of COPD, etc.² About 16 million adults in the U.S. have COPD. It is one of the top 10 causes of death in the U.S. People with COPD are also more likely to have other chronic diseases such as asthma, heart disease, and diabetes. To lower the risk of COPD, the CDC recommends stopping smoking, avoiding inhaling cigarette smoke, and avoiding places with poor air quality. In addition to symptoms, spirometry is used to diagnose the disease by measuring airflow obstruction and assessing how much air a patient can breathe in and out. Lung infections are a major complication for people with COPD which is why it is recommended to get vaccinated against COVID-19, the flu, and pneumococcal disease to protect the lungs.³ There is currently no cure for COPD, but it is treated with a combination of medications.

For treating COPD, patients must be classified into three groups: A, B, or E based on symptom burden, severity of breathlessness, and previous exacerbations, according to the GOLD guidelines. The mMRC and CAT assessments are tools used in determining which group patients belong to. The mMRC measures the severity of breathlessness in patients with COPD, and the CAT is a questionnaire that measures the effects COPD has on the patient’s quality of life.

A patient who has 0 or 1 moderate exacerbations that do not lead to hospitalization and an mMRC between 0-1 with a CAT <10, falls into group A, meaning they will receive a bronchodilator alone, such as albuterol. If a patient has 0 or 1 moderate exacerbations that do not lead to hospitalization, but an mMRC ≥2 and a CAT ≥10 , they fall within group B, meaning they will receive a Long-acting beta agonist (LABA) combined with a long-acting muscarinic-antagonist (LAMA).⁴

An example of a LABA + LAMA combination is Anoro Ellipta, which contains vilanterol (LABA) and umeclidinium (LAMA) into a single inhaler. Single-inhaler therapy is often more convenient for patients than multiple inhalers and improves patient adherence. Patients who have 2 or more moderate exacerbations or at least 1 that leads to hospitalization are classified into group E, which means they will also receive a LABA + LAMA combination therapy. An inhaled corticosteroid can be added to this therapy if the patient’s blood eosinophil levels are greater than or equal to 300, indicating inflammation. Inhaler technique should always be reviewed with patients to ensure they are correctly taking their medications.⁴

For COPD exacerbations, symptoms and severity must be assessed before considering treatment. According to the 2025 Gold Report, for managing severe but not life-threatening exacerbations, supplemental oxygen therapy is administered if levels are low. Short-acting bronchodilator dose or frequency of dosing is increased. Short acting beta 2-agonists and anticholinergics are combined. Once the patient is stabilized, long-acting bronchodilators can be considered. Based on the severity of the symptoms, oral corticosteroids and noninvasive mechanical ventilation may also be used. If signs of a bacterial infection are present, then oral antibiotics may be prescribed.⁴

COPD remains a challenging disease for patients to live with, but proper diagnosis and adherence to evidence-based treatment guidelines can help minimize exacerbations and improve patient outcomes. The GOLD guidelines recommend an individualized approach to treatment based on each patient’s quality of life, symptom severity, and exacerbation risk. Early treatment, smoking cessation, and lifestyle changes can help slow further lung damage and improve quality of life.

REFERENCES

1. National Heart, Lung, and Blood Institute. COPD – What is COPD? www.nhlbi.nih.gov. Published 2024. https://www.nhlbi.nih.gov/health/copd
2. World Health Organization. Chronic obstructive pulmonary disease (COPD). World Health Organization. Published 2024. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
3. Centers for Disease Control and Prevention. About COPD. Chronic Obstructive Pulmonary Disease (COPD). Published 2024. https://www.cdc.gov/copd/about/index.html
4. GOLD. 2025 GOLD Report – Global Initiative for Chronic Obstructive Lung Disease – GOLD. Global Initiative for Chronic Obstructive Lung Disease – GOLD. Published 2025. https://goldcopd.org/2025-gold-report/