Summarizing the 2021 Updated GOLD Guideline for COPD

Mackenzie Laisure, PharmD Candidate 2022; Nicole Covill, PharmD Candidate 2022; Marissa L. Ostroff, PharmD, BCPS, BCGP; Jared L. Ostroff, PharmD, MBA, BCACP, BCGP


US Pharmacist. 2021;46(7):30-36. 

In This Article


First-line management of COPD is dependent upon patient-specific factors such as GOLD classification and patient preference; however, nonpharmacologic and preventative methods should always be considered. Preventative methods include vaccination, including the new recommendation for a Tdap booster in patients with COPD. All patients with COPD should be prescribed a short-acting bronchodilator for immediate relief. New findings regarding triple therapy suggest that there is a significant decrease in mortality in comparison to dual bronchodilation therapy and a decrease in exacerbations and hospitalization. The management of patients at follow-up is dependent on two treatable targets: dyspnea and exacerbations.

Pharmacists can assist patients with smoking cessation and other recommendations, and tailoring therapy to patient-specific needs. A recommendation for the use of e-cigarettes over typical NRT cannot be made at this time. While studies point to conclude that its use may be effective, there is lack of data proving its safety and true efficacy. The update to the guidelines also states that the level of efficacy and benefit on lung function with the use of an ICS is lower in heavy or current smokers in comparison with light or ex-smokers.

While patients with COPD may not be at an increased risk of becoming infected with COVID-19, they are at risk for greater severity, complications, and mortality associated with infection. If a patient with COPD does become infected with COVID-19, it is recommended that they are treated with the same standard of care as other patients but may be monitored more closely with frequent rehabilitation and follow-up visits. The overall treatment for COPD should be individualized to the patient based on their specific needs and preferences.