Figure 1.

(A) Consolidated representation of the updated GOLD treatment algorithms, as interpreted by the authors. (B) Initial Pharmacological Treatment and Follow-up Pharmacological Treatment algorithms as presented in the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease report 2023.⁵

Notes: Clinicians should classify treatment-naïve patients as either Groups A, B, or E and prescribe the appropriate treatment as indicated by the algorithm. Patients already receiving treatment should begin at the most appropriate step in the algorithm. (A) adapted from Pharmacological treatment of stable COPD, Figure 4.2, and Figure 4.4, in Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease report 2023.⁵ (B) as presented in Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease report 2023⁵ (Figures 4.2 and 4.4). ©2022 Global Strategy for Diagnosis, Management and Prevention of COPD all rights reserved. Use is by express license from the owner. GOLD states that the eosinophil levels in its recommendations are estimates and not precise cutoffs. A holistic evaluation of exacerbation risk should be used to decide when initiating or escalating to ICS-containing therapy. *Single inhaler therapy may be more convenient and effective than multiple inhalers; ^†consider de-escalation of ICS if pneumonia or other considerable side-effects. In case of blood eosinophils ≥300 cells/μL de-escalation is more likely to be associated with the development of exacerbations.

Abbreviations: CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; eos, eosinophils; ICS, inhaled corticosteroid(s); FEV₁, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; mMRC, modified Medical Research Council.