The GOLD Report 2023 includes 387 new references, updates for the diagnosis and treatment of COPD, reclassifies patients into three groups, and makes changes to initial medications by patient group, among many other things.
We prepared for you a summary of some of the main updates in the 2023 GOLD COPD Guidelines, a Clinical Practice Guideline for the approach, diagnosis, and treatment of chronic obstructive pulmonary disease (COPD).
By América Torres
New COPD definition
The GOLD 2023 COPD guidelines indicate that COPD is a heterogeneous disease characterized by chronic respiratory symptoms including dyspnea, cough, sputum production and/or exacerbations. This is due to airway and/or alveoli abnormalities, resulting in persistent, and often progressive, airway obstruction.
Redefining exacerbated COPD
The Report considers exacerbated COPD to be an event characterized by increased dyspnea and/or cough and sputum that worsens within <14 days. It may be accompanied by tachypnea and/or tachycardia and is often associated with increased local and systemic inflammation caused by infection, pollution, or other airway aggressors.
Chronic Bronchitis
This new version of the Guide adds a section on chronic bronchitis, describing it as a common but variable condition in COPD patients. It is defined by the regular presence of cough with sputum production, during a defined period.
- The variability of the prevalence of chronic bronchitis (CB) depends on the definition used as a parameter, which differs regarding the regularity and duration of symptoms.
- Factors associated with the prevalence of CB in COPD include male sex, young age, higher number of packs of cigarettes per year, more severe airway obstruction, living in a rural community, and increased occupational exposure.
- Although smoking predisposes to Chronic Bronchitis, it was found that 4-22% of patients are non-smokers, indicating that there are other factors associated with this disease.
GOLD 2023 Spirometry Considerations for COPD Diagnosis and Monitoring
- Forced spirometry is the most reproducible and objective measure of airway obstruction.
- This test is non-invasive, reproducible, economically viable and easily accessible. Therefore, it should be available in any medical setting and all healthcare professionals treating COPD patients should have access to spirometry devices.
- However, peak expiratory flow by itself does not offer enough reliability to be considered as the only diagnostic test, due to its low specificity.
- Spirometry should be compared with appropriate reference values that consider the patient’s age, height, sex, and race. A post-bronchodilator response FEV1/FVC <0.7 confirms the presence of non-fully reversible airway obstruction.
- The GOLD 2023 COPD guidelines highlight that considering a fixed FEV1/FVC ratio <0.7 to define airway obstruction can lead to overdiagnosis in older adult patients and underdiagnosis in young adults.
- Assessing the degree of reversibility of airway obstruction (i.e by measuring FEV1 before and after bronchodilators or corticosteroids) to make treatment decisions is no longer recommended.
These insights from the GOLD 2023 Report reaffirm the central role of spirometry in COPD diagnosis and monitoring—but also point to its limitations in certain clinical scenarios. While spirometry is a reliable test for diagnosing COPD, at SCHILLER we agree that there are cases where it is not enough. That is why, in addition to our spirometer, SpiroScout, we offer pulmonary specialists (i.e., pulmonologists) the PowerCube Body+ Body Plethysmograph for more comprehensive testing. Both devices use ultrasonic technology.
Reducing COPD mortality
The Report added Table 3.6 (page 68), a document containing information on the clinical evidence (RCT – Randomized Controlled Trials) that support the reduction of mortality of patients suffering from COPD, both using pharmacotherapy and non-pharmacological therapy. Here we summarize some results, please review the table in the GOLD Guide 2023 for data references.
Pharmacotherapy
Therapy. LABA + LAMA + ICS. (LABA- Long-Acting Beta-Agonists. LAMA – Long-Acting Antimuscarinic. ICS – Inhaled corticosteroids).
Benefits of treatment to reduce mortality. Single inhaler therapy, compared with dual LABD (Long-Acting Bronchodilator) therapy, offers these results:
- IMPACT Clinical Trial: HR 0.72 (95% CI: 0.53, 0.99)
- ETHOS Clinical Ttrial: HR 0.51 (95% CI: 0.33, 0.80)
Type of patient. Symptomatic people with a history of frequent and/or severe exacerbations.
Non-pharmacological therapies
Therapy. Smoking cessation.
Benefits of treatment to reduce mortality. HR for the usual group, compared to the intervention group (smoking cessation): HR 1.18 (95% CI: 1.02, 1.37)
Type of patient. Asymptomatic or with mild symptoms.
Therapy. Pulmonary rehabilitation.
Benefits of treatment to reduce mortality. Previous clinical trials: RR (Risk Reduction) 0.28 (95% CI 0.10, 0.84). Recent clinical trials: RR 0.68 (95% CI 0.28, 1.67).
Type of patient. Hospitalized for exacerbated COPD (during or ≤ 4 weeks after discharge).
Therapy. Long-term oxygen therapy.
Benefits of treatment to reduce mortality. NOTT (Nocturnal Oxygen Therapy Trial) ≥ 19 continuous hours of oxygen vs. ≤ 13 hours: 50% reduction. Medical Research Council: ≥ 15 hours vs. no oxygen: 50% reduction
Type of patient. 2 RCT (Randomized Controlled Trials) in COPD patients with a PaO2 ≤ 55 mmHg at rest or < 60 mmHg with cor pulmonale or secondary polycythemia.
Therapy. Non-invasive positive pressure ventilation.
Benefits of treatment to reduce mortality. 12% in NPPV (Non-invasive Positive Pressure Ventilation) with high IPAP (Inspiratory Positive Airway Pressure) level and 33% in control group. HR 0.24 (95% CI 0.11, 0.49).
Type of patient. Stable COPD with marked hypercapnia.
Therapy. Lung volume reduction surgery.
Benefits of treatment to reduce mortality. 0.07 deaths/person-year LVRS (Lung Transplantation and Lung Volume Reduction Surgery) vs. 0.15 deaths/person-year in UC (Usual Treatment Control Group) RR (Risk Reduction) of death 0.47 (p= 0.005).
Type of patient. Upper lobe emphysema and low exercise capacity.
Additional Updates in the GOLD 2023 COPD Guidelines
Beyond the key revisions already covered, the 2023 GOLD Report includes several noteworthy additions that further refine COPD diagnosis and management, as outlined below.
- There is a new table (1.1) with COPD Etiotypes. Page 18
- Table 2.8 was included with information on the use of CT. Page 44
- Vaccine recommendations for COPD patients have been updated according to the CDC. Page 54
- Information on adherence to inhaled medicinal products was included. Page 71
- There is a section dedicated to Tele-rehabilitation. Pages 76
- A section dedicated to the choice of inhaler type was added. Page 112
- A new table (5.3) on Diagnosis and Assessment is included. Page 139
These additions complete the 2023 GOLD Report, offering clinicians a more comprehensive understanding of COPD management strategies grounded in the latest evidence and best practices. Given the extensive nature of the GOLD Report, we hope this summary of key highlights provides you with a clear and practical overview of the important changes introduced this year.
Advanced Diagnostic Tools for Accurate COPD Assessment
To support respiratory specialists in applying these guidelines effectively, SCHILLER offers a cutting-edge line of lung function testing devices designed for accuracy, reliability, and ease of us.
Our SpiroScout spirometer is a PC-based ultrasonic spirometry system that delivers accurate, reliable, and user-friendly testing for patients of all ages—including children and the elderly. Its portable design features intuitive graphics and incentive displays that simplify maneuver guidance.
Powered by LFX, SCHILLER-GANSHORN’s unified software platform for spirometry, body plethysmography, oscillometry, and diffusion testing, SpiroScout ensures built-in quality control aligned with ATS/ERS guidelines. LFX also supports seamless connectivity, including networking and EMR integration—before, during, and after testing.
The tremoflo® provides fast, non-invasive lung function assessment for asthma and COPD in both adults and children. While the patient breathes quietly, the device adds a gentle oscillatory wave, enabling three 20-second maneuvers that are easy to perform—even for patients who struggle with spirometry. The resulting waveforms offer detailed measurements of both central and peripheral airway mechanics, delivering clinically valuable data that complements traditional spirometry. Both, SpiroScout and tremoflo® utilize our advanced LFX software. This allows doctors to obtain both tests in a single report and compare the results to analyze the patient’s response to treatment.
Meanwhile, the PowerCube Body+ body plethysmograph offers advanced, comprehensive pulmonary function testing—perfect for in-depth COPD assessment.
Features:
- Standard and wheelchair versions are available
- Calibration-free SharpFlow (ultrasonic) flow sensor.
- Resistance-free measurement sensor.
- Advanced diagnostic capabilities.
- Standard measurement applications: FVC (including flow-volume loops), pediatric and adult incentive, slow spirometry.
- Complies with ATS/ERS standards.
Discover the Right Tools for COPD Care—Tailored Session Available
Discover how SCHILLER’s advanced pulmonary function testing solutions—like SpiroScout, PowerCube Body+, and tremoflo®—can transform your approach to COPD assessment and management. Schedule a personalized one-on-one session today and explore how precision testing can lead to better outcomes for your patients and your practice.