Table 1.

Summary of Changes in GOLD 2023 Report

Summary of Changes (Including Location in GOLD 2023 Report)

Definition and taxonomy

● New background information on COPD and new strategies for terminology and taxonomy have been incorporated (Chapter 1)

● A new section on chronic bronchitis has been added (Chapter 1, page 13)

● A new definition of COPD has been proposed: COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction (Chapter 1, page 5)

● A new definition of COPD exacerbation has been proposed, and a new set of parameters to assess exacerbation history has been included: an exacerbation of COPD is defined as an event characterized by dyspnea and/or cough and sputum that worsens in <14 days and is often associated with increased local and systemic inflammation caused by airway infection, pollution, or other insult to the lungs (Chapter 1, page 134)

Diagnosis

● Additional information on screening and case finding has been included (Chapter 2, page 36)

● New information on imaging and CT has been included (Chapter 2, page 43)

● The ABCD grouping system has been updated to the ABE model to recognize the clinical relevance of exacerbations, independent of the level of symptoms (Chapter 2, page 40; Chapter 4, page 115)

Exacerbation management ● The topic of management of exacerbations has been expanded to include details of possible alternative causes of symptoms and a new table on diagnosis and assessment (Chapter 5, page 136)

Disease management: pharmacological therapies

● The information and figures outlining initial pharmacological treatment and follow-up pharmacological treatment have been updated; in particular, the positioning of LABA + LAMA and ICS + LABA have been updated (Chapter 4, page 115)

● Further information on therapeutic interventions to reduce COPD mortality has been included (Chapter 3, page 67)

● Issues related to inhaled delivery have been addressed (Chapter 3, page 69)

● Information on the topic of adherence to inhaled COPD medications has been included (Chapter 3, page 71)

● New information on the choice of inhaler device has been added (Chapter 4, page 112)

Disease management: non-pharmacological therapies

● Vaccination recommendations for people with COPD have been updated in line with current guidance from the Centre for Disease Control and Prevention (Chapter 3, page 54)

● A section on tele-rehabilitation has been added (Chapter 3, page 76)

● The section on interventional and surgical therapies for COPD has been expanded (Chapter 3, page 82)

Comorbidities

● The sections on COPD and comorbidities and COVID-19 and COPD have been updated with the latest evidence (Chapter 6, page 154; Chapter 7, page 169)

Notes: Adapted from the GOLD 2023 Report Highlights, Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease report 2023.⁵ Chapters and page numbers from the GOLD 2023 Report are included in the table for ease of reference.

Abbreviations: COPD, chronic obstructive pulmonary disease; CT, computed tomography; ICS, inhaled corticosteroid(s); LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist.