The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established by leading national and world health organizations to work with healthcare professionals and public health officials to raise worldwide awareness of chronic obstructive pulmonary disease (COPD) and to improve methods for prevention and treatment of COPD. GOLD works with international experts to develop guidelines and resources for the diagnosis, prevention, and management of COPD.

Gold guidelines advise treating moderate to very severe COPD with long-acting bronchodilators¹⁰

• One or more long-acting bronchodilators from different pharmacologic classes are recommended in patients with moderate to very severe COPD who are not adequately relieved with as-needed short-acting bronchodilators
• Inhaled short-acting bronchodilators are recommended as needed in patients with all stages of COPD
• Inhaled corticosteriods are reserved for patients with severe or very severe stages of COPD and a history of repeated exacerbations

Stage by stage: Managing patients with COPD*_†

Stage 1: Mild FEV1/FVC <0.70 FEV1 <80% predicted	Stage 2: Moderate FEV1/FVC <0.70 FEV1 50% and <80% predicted	Stage 3: Severe FEV1/FVC <0.70 FEV1 30% and <50% predicted	Stage 4: Very Severe FEV1/FVC <0.70 FEV1 <30% predicted or FEV1 <50% predicted + chronic respiratory failure
Active reduction of risk factors; provide influenza vaccine
Add short-acting bronchodilator (when needed)
	Add regular treatment with 1 or more long-acting bronchodilators (when needed) Add pulmonary rehabilitation
		Add inhaled glucocorticosteroids if repeated exacerbations
			Add long-term oxygen if chronic respiratory failure; consider surgery

* Postbronchodilator FEV₁ is recommended for the diagnosis and assessment of severity of COPD.

†Adapted from GOLD guidelines.