Disease stability in COPD following GOLD 2026-aligned initial therapy: a retrospective real-world study

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 introduces the concept of “disease stability” (DS), classifies patients with ≥1 moderate exacerbation in the previous year as Group E, and recommends long-acting beta 2 -agonist (LABA) + long-acting muscarinic antagonist (LAMA) or inhaled corticosteroid (ICS) + LABA + LAMA for Group E, LABA + LAMA for Group B, and bronchodilator monotherapy for Group A. This study evaluated DS in patients whose inhaled therapy was aligned with the GOLD 2026 initial treatment strategy and explored associated factors. This retrospective analysis of real-world data included patients enrolled between 1 November 2017 to 30 June 2024. Based on adherence to the initial inhaled therapy recommendations outlined in the GOLD 2026 report, patients were categorised as either aligned or non-aligned; the non-aligned group was further divided into under-treated and over-treated subgroups. DS was defined as the absence of exacerbations, no symptom deterioration, and a decline in FEV 1 of less than 60 mL during 1 year of follow-up. A total of 1277 patients were enrolled, of whom 475 (37.2%) achieved DS during the 1-year follow-up. Among patients in the aligned group, 238 (41.0%) achieved DS. Compared with the non-aligned group, the aligned group showed a lower incidence of clinically important deterioration (CID) in the CAT score, fewer future exacerbations, and a higher rate of DS. Subgroup analysis showed that the aligned group had higher odds of DS than the under-treated group, whereas no significant difference was observed compared with the over-treated group. Among patients in GOLD Groups B and E, alignment with the GOLD 2026 recommendations was associated with a higher rate of DS and a lower risk of exacerbations and CID. Influenza or pneumococcal vaccination showed a modest positive association with DS, whereas current smoking and a history of exacerbations were negatively associated with DS among patients receiving GOLD 2026-aligned initial therapy. Alignment with GOLD 2026 initial treatment recommendations was associated with improved DS, particularly in GOLD Groups B and E. Current smoking and a history of exacerbations reduced the likelihood of achieving DS, whereas influenza or pneumococcal vaccination showed a modest positive association with DS.