Major GOLD Guideline Change for COPD

The Impact of OPRI, the University of Exeter, and OPCRD Data

The 2026 update to the GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines marks a significant shift in how clinicians assess exacerbation risk in COPD. For the first time, just one moderate exacerbation in the previous year is now sufficient to classify a patient as higher risk, prompting earlier intervention and more proactive management.

This change is underpinned by robust real-world evidence, particularly from a landmark study led by David Halpin and the Observational & Pragmatic Research Institute (OPRI). The study was funded by OPRI and conducted in collaboration with the University of Exeter, where David is Honorary Professor of Respiratory Medicine.

This study found that in newly diagnosed COPD patients, having even a single exacerbation in the year before diagnosis strongly predicts a higher risk of exacerbations in the following year, with risk increasing as the number or severity of prior events rises. The study used the OPC Research Database (OPCRD), a rich source of primary care data for epidemiology, with the findings of the study providing the critical evidence base for this global guideline revision.

This is a prime example of how UK-based academic-industry partnerships can drive international best practice, directly improving patient care worldwide.

Rates of moderate or severe exacerbations in the last 12 months after diagnosis with 95% confidence intervals, according to exacerbation history in the 12 months prior to diagnosis and whether maintenance therapy was started.

Reference:

Halpin DMG, Healey H, Skinner D, Carter V, Pullen R, Price D. Exacerbation history and blood eosinophil count prior to diagnosis of COPD and risk of subsequent exacerbations. Eur Respir J 2024; 64(4): 39147410. PubMed