Last reviewed: 26 Apr 2022
Last updated: 20 Dec 2021
20 Dec 2021

Updated GOLD guideline includes new information on vaccination, eosinophil testing and lung cancer screening

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released the 2022 version of its comprehensive report on the diagnosis, management, and prevention of COPD. Updated information includes:

  • Testing blood eosinophil levels can help identify patients who are most likely to benefit from post-stabilization inhaled corticosteroids, to reduce the risk of further exacerbations.

  • Vaccination recommendations from the US Centers for Disease Control and Prevention for COVID-19 vaccine for all people with COPD; and Zoster (shingles) vaccine for those ages ≥50 years.

  • A recommendation for annual low-dose CT scanning for lung cancer in patients with COPD due to smoking (in line with US Preventive Services Task Force recommendations).

See Diagnosis: approach

See Management: approach

Original source of update



History and exam

Key diagnostic factors

  • dyspnea
  • cough
  • wheeze
  • changes in sputum volume/color/thickness
  • tachypnea
  • cyanosis

Other diagnostic factors

  • past medical history of COPD
  • tobacco use
  • past medical history of gastroesophageal reflux/swallowing dysfunction
  • malaise and fatigue
  • chest tightness
  • features of cor pulmonale
  • environmental/occupational exposure to pollutants or dust
  • change in mental status
  • fever
  • accessory muscle use
  • paradoxical movements of abdomen

Risk factors

  • viral infection
  • bacterial infection
  • gastroesophageal reflux/swallowing dysfunction
  • smoking
  • atypical bacterial infection
  • air pollutants
  • change in weather

Diagnostic investigations

1st investigations to order

  • oxygen saturation on pulse oximetry
  • chest x-ray
  • ECG
  • ABG
  • CBC with platelets
  • electrolytes, BUN, + creatinine

Investigations to consider

  • sputum culture + Gram stain
  • respiratory virus diagnostics
  • cardiac troponin
  • CT scan of chest

Emerging tests

  • procalcitonin
  • C-reactive protein
  • eosinophil count

Treatment algorithm



Carolyn L. Rochester, MD

Professor of Medicine

Yale School of Medicine

New Haven

VA Connecticut Healthcare System

West Haven



CLR serves on the COPD scientific advisory board for GlaxoSmithKline Pharmaceuticals but has no competing interests pertaining to this publication.

Richard A. Martinello, MD

Associate Professor

Yale School of Medicine

New Haven



RAM declares that he has no competing interests.

Peer reviewers

Sanjay Sethi, MD

Professor of Medicine

Division Chief

Pulmonary/Critical Care/Sleep Medicine

University at Buffalo

State University of New York

Section Chief

Pulmonary/Critical Care/Sleep Medicine

VA Western New York Healthcare System




SS declares that he has no competing interests.

Francis Thien, MD, FRACP, FCCP


Box Hill Hospital and Monash University




FT declares that he has no competing interests.

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