The new Spanish Guideline for Chronic Obstructive Pulmonary Disease (GesEPOC 2025) is now available and includes an in-depth update of the recommendations for diagnosis, follow-up, and treatment. The document, published in the Archivos de Bronconeumología, has been directed and coordinated by Dr. Marc Miravitlles, pulmonologist at Vall d’Hebron University Hospital and principal investigator of the Pulmonology Group at Vall d’Hebron Research Institute (VHIR), who is also the first author.

This new edition, which reinforces Vall d’Hebron’s role in generating knowledge and improving care for patients with chronic respiratory diseases, is the result of joint work by the main medical societies involved in the care of COPD: pulmonology, internal medicine, hospital pharmacy, and primary care. The outcome is a consensus document that updates clinical practice according to the most recent scientific evidence and serves as a reference for professionals across the country.

A prevalent disease that requires updated criteria

COPD is one of the most common chronic diseases and one of the leading causes of morbidity and mortality worldwide. Strongly linked to smoking and exposure to inhaled irritants, it is a progressive condition that can lead to respiratory limitation, recurrent exacerbations, and a significant impact on quality of life.

Given this clinical and social burden, having an updated guideline is essential to harmonise diagnosis, identify high-risk patients, and guide treatment at each stage of the disease. “The guideline is intended to help every professional, from primary care to hospital settings, make decisions based on uniform and evidence-based criteria,” explains Dr. Miravitlles.

Towards more personalised treatment

The new GesEPOC introduces advances in patient classification, identification of clinical phenotypes, and selection of the most appropriate treatment according to risk and characteristic clinical traits. The document also highlights the importance of improving early diagnosis, which remains insufficient yet is key to better prognosis, and identifying the so-called “treatable traits” that can influence disease evolution, such as chronic bronchitis, recurrent exacerbations, or eosinophilia.

Furthermore, the guideline thoroughly reviews the role of the available treatments and establishes updated criteria for their optimal use. One of the most notable changes is the incorporation of an evidence-based decision model that combines symptoms, exacerbation risk, and biomarkers, particularly blood eosinophils, to guide the use of inhaled corticosteroids and other advanced therapies. It also redefines the role of bronchodilators and updates the situations in which treatment should be intensified or reduced, with the aim of improving clinical control and avoiding unnecessary adverse effects.

GesEPOC 2025 also introduces clearer criteria to identify patients who may benefit from additional treatments such as mucolytics, long-term macrolides, or biological therapies targeting specific inflammatory profiles. The document incorporates new evidence on these options and provides consensus recommendations to help professionals more accurately select those that offer real benefit. With this approach, the guideline reinforces the need for comprehensive and continuous management in which patient evolution and clinical response are central to adjusting treatment over time.

“The update brings together all the knowledge accumulated in recent years and organises it to make it useful in everyday practice. Our goal is for the guideline to support precise decisions that help prevent exacerbations and improve clinical outcomes,” notes Dr. Miravitlles. He also highlights that the update responds to the need to integrate new treatments and better define the profiles that may benefit from them: “In recent years, innovative therapeutic options have emerged and it was essential to update the criteria to ensure rigorous use. Moreover, working jointly with specialists from different fields provides a broad perspective and ensures the guideline adapts to all care settings.”