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COPD guideline registry¶
Literature evidence checked: 2026-10-27 (periodic sweep; new material pending independent audit). Official pages accessed: 2026-10-27. GOLD 2026 and the COPD-X redevelopment page were retrieved through browser search/open despite direct HTTP 403; NICE NG115 remains last updated 26 July 2019. A GOLD 2027 report was not located in the official-site search; direct retrieval was blocked, so availability is not conclusively excluded.
Master table¶
| Body | Year/version | Region | Scope | Citation/URL | Status |
|---|---|---|---|---|---|
| GOLD | 2026 | Global | Full strategy | https://goldcopd.org/2026-gold-report-and-pocket-guide/ | current; re-accessed 2026-10-20, no 2027 edition posted |
| ATS | 2020 | USA | Stable pharmacotherapy | Nici et al., PMID 32283960 | current |
| ATS | 2020 | USA | Home oxygen | Jacobs et al., PMID 33185464 | current |
| ATS | 2020 | USA | Long-term NIV in stable hypercapnic COPD | Macrea et al., PMID 32795139 | current |
| ERS | 2020 | Europe | ICS withdrawal | Chalmers et al., PMID 32366483 | current |
| ATS | 2023 | USA | Pulmonary rehabilitation and telerehabilitation | Rochester et al., PMID 37581410 | current |
| ERS | 2019 | Europe | Long-term home NIV | Ergan et al., PMID 31467119 | current |
| ERS/ATS | 2017 | Europe/USA | Exacerbation management | Wedzicha et al., PMID 28298398 | current; aging |
| Canadian Thoracic Society | 2023 | Canada | Stable pharmacotherapy | Bourbeau et al., PMID 37690008 | current |
| TSANZ/Lung Foundation Australia | 2025 v2.78 | Australia/New Zealand | Full COPD-X plan | https://copdx.org.au/ | current available edition; routine surveillance paused during redevelopment (official page rechecked 2026-10-27) |
| Australian/NZ PR group | 2017 | Australia/New Zealand | Pulmonary rehabilitation | Alison et al., PMID 28339144 | current; aging |
| NICE | 2018, updated 2019 | UK | Diagnosis and management | https://www.nice.org.uk/guidance/ng115 | current; surveillance reviewed 2022 |
| GesEPOC | 2021 (published 2021–2022) | Spain | Stable pharmacotherapy and exacerbation syndrome | Miravitlles et al., PMID 33840553; Soler-Cataluña et al., PMID 34172340 | current suite |
| ERS | 2017 | Europe | Alpha-1 antitrypsin deficiency | Miravitlles et al., PMID 29191952 | current statement; aging |
| USPSTF | 2022 reaffirmation | USA | Screening asymptomatic adults | Recommendation statement, PMID 35536260 | current; distinct from targeted case-finding |
| Czech Pneumological and Phthisiological Society | 2020 | Czechia | Stable COPD organized by clinical phenotypes and treatable traits | Zatloukal et al., PMID 33325455 | current at publication; supersession should be checked locally |
| Japanese Respiratory Society | 7th edition, March 2026 | Japan | Full management guideline (stable and exacerbation) | Sugiura et al., PMID 42447589 (English summary) | current; supersedes 6th edition (2022) |
| AARC | 2026 | USA | Adults transitioning from hospital on oxygen | Craddock et al., PMID 42713935 | current |
| GOLD / GLI | 2026 joint statement | Global | Spirometric definition of airflow obstruction | Halpin et al., PMID 41748283 | current position statement; contested for global-South applicability (Burney et al., PMID 42562597) |
Current documents¶
GOLD 2026¶
Annual global strategy with sections spanning definition, diagnosis, prevention, stable treatment, exacerbations and comorbidity. The official site describes a twice-yearly literature review and annual update. The 2026 revision modifies exacerbation-risk grouping and adds emerging-technology content (GOLD — “2026 GOLD Report and Pocket Guide,” https://goldcopd.org/2026-gold-report-and-pocket-guide/, accessed 2026-08-30).
ATS pharmacologic management 2020¶
Addresses LABA/LAMA versus monotherapy, triple therapy, ICS withdrawal, oral steroids and opioids using evidence-graded recommendations (Nici 2020, PMID 32283960).
ATS home oxygen 2020¶
Separates severe resting hypoxemia, moderate hypoxemia, exertional desaturation and equipment/safety considerations (Jacobs 2020, PMID 33185464).
ATS long-term NIV 2020¶
Conditionally supports nocturnal NIV in stable hypercapnic COPD (moderate certainty), recommends reassessment 2–4 weeks after acute resolution rather than inpatient initiation (conditional, low certainty), and supports PaCO2-targeted ventilation (conditional, low certainty) (Macrea 2020, PMID 32795139).
ERS ICS withdrawal 2020¶
Conditionally supports ICS withdrawal without frequent exacerbations, strongly advises against withdrawal when blood eosinophils are at least 300/µL, and strongly requires long-acting bronchodilator treatment after withdrawal (Chalmers 2020, PMID 32366483).
ATS pulmonary rehabilitation 2023¶
Strongly recommends PR in stable COPD and after hospitalization and offers a choice between center-based and telerehabilitation (all moderate-certainty); maintenance PR after completion is conditional with low-certainty evidence (Rochester 2023, PMID 37581410).
ERS home NIV 2019¶
Conditionally addresses stable hypercapnic COPD, persistent hypercapnia after acute NIV, CO2-targeting and ventilator mode (Ergan 2019, PMID 31467119).
ERS/ATS exacerbations 2017¶
Covers corticosteroids, antibiotics, NIV, home-based management and post-event rehabilitation; newer biomarker-guided steroid trials postdate it (Wedzicha 2017, PMID 28298398).
Canadian Thoracic Society 2023¶
Provides an evidence-based stable pharmacotherapy pathway with symptoms, exacerbations and eosinophils (Bourbeau 2023, PMID 37690008).
COPD-X 2025¶
The Australian/New Zealand plan historically used frequent updates and organizes content as Case finding/Confirm diagnosis/Optimise function/Prevent deterioration/Develop support network/Manage exacerbations. Version 2.78 was live on the official site (COPD-X — “Australian and New Zealand guidelines,” https://copdx.org.au/, accessed 2026-08-30). Currency correction 2026-10-27: the redevelopment notice (dated 28 July 2026) says routine evidence surveillance is temporarily paused, version 2.78 (December 2025) remains available, and biologic recommendations are planned for late 2026. This is a change in update process, not a newly issued clinical recommendation (COPD-X — “COPD-X Redevelopment,” https://copdx.org.au/copd-x-redevelopment-documents/, accessed 2026-10-27).
NICE NG115¶
UK guidance covers diagnosis, non-pharmacologic and inhaled treatment, multidisciplinary care and exacerbations. Published 2018 and updated 2019; NICE states surveillance did not trigger update in 2022 (NICE — “COPD in over 16s: diagnosis and management,” https://www.nice.org.uk/guidance/ng115, accessed 2026-08-30).
JRS 7th edition 2026¶
GRADE/Minds-graded national guideline. It adopts the GOLD 2023 etiotype classification, treats CT mucus plugging as an independent prognostic factor, makes peri-exacerbation cardiovascular risk a core management goal, and adds seven clinical questions (CQ16–22) on long-term macrolides, bronchoscopic lung-volume reduction and exacerbation care. It newly recommends dupilumab for type-2 COPD with frequent exacerbations (Sugiura 2026, PMID 42447589).
AARC hospital-to-home oxygen 2026¶
Six GRADE recommendations. Disease management for newly prescribed LTOT is a strong recommendation (low certainty), and regular reassessment after discharge is conditional (moderate certainty). The rest are conditional and low certainty: discharge coordination, rest and activity oxygen assessment, a home burn-risk evaluation, and peri-discharge education (Craddock 2026, PMID 42713935).
GOLD/GLI joint statement 2026¶
A viewpoint, not a graded guideline. GOLD and GLI agree that spirometry alone does not make the diagnosis, that few people are classified differently by the fixed ratio and the LLN, and that the fixed ratio can be used in the appropriate clinical context (Halpin 2026, PMID 41748283).
Czech phenotype/treatable-traits position 2020¶
This national position combines randomized and real-world evidence but makes clinical phenotypes and treatable traits the organizing structure for stable care, in contrast to documents built mainly around symptom and exacerbation strata (Zatloukal 2020, PMID 33325455). The PubMed record does not provide GRADE certainty labels for individual statements; recommendation-strength comparisons therefore require the full document and should not be inferred from its phenotype terminology.
Disagreements and gaps¶
| Topic | Position A | Position B / gap |
|---|---|---|
| Initial dual bronchodilation | Earlier LABA/LAMA for symptomatic patients | Some systems retain stepwise monotherapy for cost/feasibility |
| ICS thresholds | Eosinophils as continuous benefit modifier | Operational cutoffs differ and repeatability is under-specified |
| Triple-therapy mortality | Trial secondary analyses support possible benefit | Withdrawal/enrichment and pneumonia complicate causal interpretation |
| Moderate/exertional oxygen | Conditional individual assessment | LOTT does not support routine hard-outcome benefit |
| Home NIV | Selected persistent hypercapnia | PaCO2 threshold, timing and titration resources differ |
| Biologics | Dupilumab evidence now positive | Many guidelines predate approval/replication and sequencing data |
| Case-finding | Target symptomatic/exposed groups | Long-term outcome benefit and best prescreen unclear |
| Low-resource implementation | Adapt to local systems | Few documents specify minimum viable care when inhalers/spirometry are scarce |
| Fixed ratio versus LLN | GOLD retains fixed post-BD FEV1/FVC <0.70 | LLN reduces age-related misclassification but lacks one universally adopted clinical-action rule (Wang 2013, PMID 24034095) |
| Acute steroid duration | Contemporary practice commonly uses five days after REDUCE | ERS/ATS 2017 predates some biomarker-directed reduction evidence (Leuppi 2013, PMID 23695200; Sivapalan 2019, PMID 31122894) |
| Valve versus LVRS | Both endorsed for highly selected emphysema | CELEB found no significant 12-month i-BODE difference in 88 randomized participants, with complete primary outcomes in 49; patient-level assignment remains imprecise (Buttery 2023, PMID 36796833) |
| Mepolizumab/tezepelumab | MATINEE supports mepolizumab in selected eosinophilic COPD | COURSE overall result and earlier benralizumab neutrality show that pathway/cutoff extrapolation is unsafe (Sciurba 2025, PMID 40305712; Singh 2025, PMID 39653044; Criner 2019, PMID 31112385) |
| Phenotype architecture | Czech guidance places named phenotypes/treatable traits at the center of stable management (Zatloukal 2020, PMID 33325455) | GOLD/ATS pathways more directly operationalize symptoms, exacerbations, bronchodilation and eosinophils; no randomized strategy comparison establishes a superior architecture |
Evidence-change ledger for updates¶
| Evidence | Result that an update must incorporate | Documents most affected |
|---|---|---|
| WISDOM, PMID 25196117 | ICS withdrawal exacerbation HR 1.06 (95% CI 0.94–1.19), with 43-mL trough FEV1 loss | Stable pharmacotherapy and de-escalation |
| REDUCE, PMID 23695200 | Five-day prednisone non-inferior to 14 days; approximately halved cumulative exposure | ERS/ATS exacerbation guidance |
| CORTICO-COP, PMID 31122894; STARR2, PMID 37924830 | Biomarker-guided acute steroids reduce exposure in hospital and primary-care contexts | Exacerbation and biomarker guidance |
| LOTT, PMID 27783918 | No death/first-hospitalization benefit in moderate desaturation | Oxygen guidance; prevent extrapolation from severe hypoxemia |
| Köhnlein, PMID 25066329; HOT-HMV, PMID 28528348 | Benefit with persistent hypercapnia and effective CO2 reduction | Home-NIV thresholds and service standards |
| BOREAS/NOTUS, PMIDs: 37272521, 38767614 | Replicated dupilumab benefit in selected type-2 chronic-bronchitis COPD | Pharmacotherapy/biologic sequencing |
| MATINEE, PMID 40305712 | Mepolizumab event rate ratio 0.79 (95% CI 0.66–0.94), no significant symptom/QoL difference | Biologic placement and outcome expectations |
| COURSE, PMID 39653044 | Overall tezepelumab result did not establish broad efficacy | Alarmin-biomarker enrichment and trial interpretation |
| ENHANCE, PMID 37364283 | Replicated FEV1 benefit and event signal; inconsistent patient-reported replication | Placement of ensifentrine relative to long-acting inhalers |
| TRANSFORM, PMID 28885054 | Large selected valve benefit with 29.2% pneumothorax | Procedural selection, monitoring and referral-center standards |
| UCAP early diagnosis, PMID 38767248 | Case-finding plus specialist/educator care reduced respiratory health-care use, but asthma and COPD were pooled | Screening/case-finding guidance; separate diagnostic yield from outcome-changing care |
| STEPINCOPD, PMID 39560105 | Reported GOLD concordance was 81.6% initially and 92.9% at follow-up in a selected treatment-change cohort | Implementation metrics and the role of spirometry in treatment change |
| OBERON/TITANIA, PMID 42708515 | Tozorakimab exacerbation RR about 0.70 in two phase 3 trials, without an eosinophil criterion | All pharmacotherapy documents; first eosinophil-independent biologic evidence |
| ALIENTO/ARNASA, PMIDs: 42150581, 42148875 | Astegolimab RR 0.85 in both trials, significant only in phase 2b; pooled 0.85 (0.76–0.96) | Biologic placement; how to weigh a pooled estimate when the confirmatory trial missed |
| Cochrane AATD augmentation 2026, PMID 42626936 | IV augmentation: no mortality difference shown, possible slight exacerbation increase (low certainty) | ERS AATD statement refresh; augmentation eligibility |
| Swedish metoprolol RCT, PMID 42701865 | No composite benefit (HR 0.87, 0.73–1.05) in COPD without cardiovascular disease | Comorbidity sections; reinforces BLOCK COPD |
| AIRFLOW-3, PMID 40920914 | Targeted lung denervation missed its exacerbation endpoint (HR 1.268, 0.988–1.628) | Bronchoscopic-therapy sections |
Supersession chains¶
- GOLD executive summary 2013 (PMID 22878278) → annual GOLD strategy revisions → GOLD 2026 official report.
- NICE CG101 (2010) → NICE NG115 (2018) → 2019 targeted update; current surveillance page remains active.
- COPD-X earlier versions → rolling quarterly updates → version 2.78 (2025) at access date.
- GesEPOC 2012 original → 2014 update (PMID 24507959) → GesEPOC 2021 stable pharmacotherapy (PMID 33840553) and exacerbation-syndrome update (PMID 34172340).
- JRS 6th edition (2022) → JRS 7th edition (March 2026; PMID 42447589). The 6th edition is not separately catalogued here.
Watch list¶
- GOLD annual report and pocket-guide revisions (no GOLD 2027 page on 2026-10-20; whether it incorporates tozorakimab and the GOLD/GLI statement is the next check).
- NICE surveillance decision after dupilumab/ensifentrine evidence.
- ERS/ATS exacerbation guideline update incorporating biomarker-guided steroids.
- ATS pharmacotherapy update incorporating biologics.
- ERS AATD statement refresh and augmentation eligibility, now against the 2026 Cochrane update (PMID 42626936).
- COPD-X redevelopment: watch for the planned late-2026 biologic recommendations and resumption of evidence surveillance; do not assume quarterly updates continue.
- Czech phenotype-position supersession and availability of explicit recommendation grades.
Candidate awaiting completion of verification — 2026-10-27¶
- Chinese Thoracic Society / Chinese Association of Chest Physicians, 2026 revision — live PubMed identifies a national diagnosis/management guideline building on the 2021 edition: Chinese guidelines for the diagnosis and management of chronic obstructive pulmonary disease (2026 revision). Zhonghua Jie He He Hu Xi Za Zhi. 2026;49:1146–1191. PMID 42933872. [unverified: Crossref retraction check incomplete] The PubMed publication types contain no retraction/expression-of-concern flag, but the supplied DOI returns Crossref HTTP 404 and its full text was not retrieved. Catalogue as a candidate only; recommendation synthesis and supersession mapping await the full document and a successful second retraction check.