Discussing New Updates to GOLD 2025 Report, with Gerard Criner, MD

A set of recent updates were included in the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report related to care for chronic obstructive pulmonary disease (COPD), with 3 additional sections as well as several revisions having been made to reflect newer developments in care and in research.^1,2,3

The newly-updated guidelines, presented by Claus F. Vogelmeier, MD, during the 2024 GOLD COPD conference, included 3 new sections related to cardiovascular risk, pulmonary hypertension, and global climate change. These sections and other updates were highlighted in a new interview with Gerard J. Criner, MD, FACP, FACCP, chair and professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University.

“The importance of cardiovascular disease in patients with COPD probably can't be overstated,” Criner explained. “What we did in this revision is, besides increasing the awareness that about 25% of the patients with COPD have significant cardiovascular disease, really tie the major acute cardiac events that commonly happen in patients following an acute exacerbation of COPD. Especially severe exacerbations, which require hospitalization. There's a timeline following the risk of cardiovascular events that are significant, and that can contribute to mortality.”

Criner stressed that physicians must be aware of complications related to cardiovascular risk, the different phenotypic descriptions, and generally of the risk of pulmonary hypertension. He touched upon the new section on pulmonary hypertension as well.

“It's really the assessment and the diagnosis of [pulmonary hypertension] using less invasive tools, the first being echocardiography and then some other tools like serologic measurements with BMP, looking at the EKG, and looking at their patients oxygen assessment overall. Then, it's really assessing the status of their lung disease by using routine testing of spirometry but also diffusion capacity in a CAT scan to look at this description. Then, following that with the VQ scan and with some detailed testing in some individuals with using 6 minute walk or cardiopulmonary exercise tests.

Criner noted that, provided patients are hyperinflated with COPD, when clinicians are looking for pulmonary vascular disease, the echocardiogram may be somewhat inadequate to receive a true assessment of cardiac function in certain patients. In such cases, he noted that a cardiac MRI may need to be done.

“Then finally, if a significant pulmonary hypertension is found, and the clinician thinks that's contributing to the patient's status, which it's important to diagnose and treat, then referring to a pH center and a right heart catheterization is suggested,” Criner explained.

He then touched upon climate change and its impact on patients with COPD, noting the new section on this topic in the GOLD Report.

“I think most of the world is experiencing things that are related to climate change, with changes in temperature and changes in pollution and wildfires as exposures that are affecting us globally,” Criner said. “For many of the causes of COPD in the past, we thought climate would exacerbate patients that had COPD…But now it's clear that in the future, with these changes in climate besides exacerbating the current disease that might be caused by other factors, that climate change by itself with pollutants, natural pollutants, and industrial pollutants complicated by derangements that happen with temperature change, could be an important part of the complex of symptoms or drivers of patients with COPD having worsening symptoms or developing an exacerbation.”

For additional information, view the full interview posted above. For more about the GOLD updates, view our summary here.

The quotes contained in this summary were edited for clarity.

Criner has reported receiving grants from Temple University, GSK, Chiesi, Pulmonx, AstraZeneca, and Gilead. He also has reported serving on data and safety monitoring boards for Chiesi, Sanofi, and Olympus education and receiving consulting fees from GSK, AstraZeneca Chiesi, Regeneron, Sanofi, and Apreo.

References

1. ^{Global initiative for chronic obstructive lung disease 2025 report. https://goldcopd.org/wp-content/uploads/2024/11/GOLD-2025-Report-v1.0-12Nov2024_WMV-Draft.pdf. Date accessed: November 29, 2024.}
2. ^{GOLD report 2025 key changes summary. https://goldcopd.org/wp-content/uploads/2024/11/KEY-CHANGES-GOLD-2025-11Nov2024.pdf. Date accessed: November 29, 2024.}
3. ^{Hornick I. 2025 GOLD report addresses cardiovascular risk, climate change, pulmonary hypertension. Healio. November 14, 2024. https://www.healio.com/news/pulmonology/20241114/2025-gold-report-addresses-cardiovascular-risk-climate-change-pulmonary-hypertension#:~:text=The%202025%20report%20also%20features,the%20figure%20in%20the%20report. Date accessed: November 29, 2024.}