The 2025 report from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) is out, and clinicians are taking note of some significant changes. At the forefront of these annual amendments is the notable exclusion of a devoted chapter to COVID-19.

“Treating a patient with COVID-19 and COPD or a patient with COVID-19 without COPD is pretty much the same since COVID-19 has moved from a pandemic to an endemic virus,” said Gerard J. Criner, MD, FCCP, a member of the GOLD Science Committee.

“For patients with COPD, we should give COVID-19 the same sort of attention we give to influenza, respiratory syncytial virus, or pertussis; that vaccination is needed,” said Dr. Criner, who is also Professor and Chair of Thoracic Medicine at the Lewis Katz School of Medicine and Surgery at Temple University. “If patients need to be treated for COVID-19, they should get Paxlovid or remdesivir, similar to any patient who does not have COPD.”

Another significant change is the adoption of race-neutral algorithms and equations in predictive values for lung function testing and the severity of lung impairment. Global Lung Function Initiative (GLI) reference values and equations are now the accepted norms for lung volumes and other lung functions.

The race-neutral approach, which has already been adopted in other practice areas, carries important implications for individual patients as well as clinicians.

“Changing predicted values for lung function changes not only who might be interpreted as having an impairment but also derivative downstream implications in terms of who might be eligible for lung transplantation and other therapies,” Dr. Criner said. “If the predicted normals change, disabilities are going to change.”

Race-neutral norms will likely result in more lung function abnormalities for Black patients and fewer for White patients, Dr. Criner noted. Using a fixed ratio to determine airflow structure or the lower limit of normal carries the potential for underdiagnosis in younger populations and overdiagnosis in older populations, among other changes.

“There are pros and cons for any change, whatever population you look at,” Dr. Criner said. “Trying to give someone a disease they may not have or a therapy they may not need, or ignoring a disease or treatment for people who may benefit, are important ramifications.”

Using GLI reference values also simplifies spirometry, which the authors of the GOLD report hope will spur greater use of spirometry. Only 15% to 20% of patients who should have spirometry currently get it, Dr. Criner said.

“We want to encourage spirometry to define the presence or absence of airflow obstruction,” he said. “We advocate for the use of prebronchodilator spirometry and then postbronchodilator spirometry to make it simpler and easier to find people with airflow obstruction.”

Also new this year is an emphasis on the importance of CAT scans. Virtually all patients with COPD qualify for annual low-dose CT screening for lung cancer based on their smoking exposure. Lung cancer screening or other CT imaging can help to identify structural features commonly seen in emphysema or bronchiectasis as well as lung nodules and other abnormalities that should not be ignored.

This year’s GOLD report also brings greater recognition that features of both COPD and asthma can and do coexist in some patients. Treatment should be tailored to individual patient needs. About 30% of patients with COPD have type 2 inflammation with elevated peripheral blood eosinophils, Dr. Criner said. Last year, the GOLD report outlined the role of inhaled corticosteroid therapy in these patients. This year, the report expanded treatment options for patients with COPD with type 2 inflammation to include treatment with dupilumab and called out the potential role of anti-IL-5 therapy with the promising phase 3 trial of mepolizumab.