Why One Exacerbation Matters in COPD: David Halpin, MA, DPhil

A single moderate exacerbation of chronic obstructive pulmonary disease (COPD) carries important information about future risk and should prompt clinicians to optimize care, according to David Halpin, MA, DPhil, MBBS, consultant physician and senior lecturer in respiratory medicine at the University of Exeter.

In an interview with The American Journal of Managed Care^®, Halpin discussed the prognostic weight of moderate exacerbations, the more ambitious targets in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 report, and the barriers to optimal treatment.

Why Moderate Exacerbations Carry Risk

A moderate exacerbation does not require hospitalization but does require treatment with antibiotics or steroids, Halpin explained. There is a lot of evidence that even one such event carries important information about the risk of future exacerbations.

It is also related to a faster decline in lung function and a deterioration in health status and quality of life, he said. It affects functional capacity, including the ability to walk and potentially to live independently.

“Preventing moderate exacerbations is really important because they themselves carry a bad prognosis,” Halpin said.

An exacerbation should be a wake-up call to ask what else can be done to optimize management, he added. That includes making sure patients can use their drugs and devices correctly, as well as nonpharmacologic approaches such as smoking cessation, exercise therapy, and vaccination.

What GOLD 2026 Changed

In the 2026 report, GOLD moved the threshold down and introduced more ambitious treatment targets on the belief that one exacerbation is one too many. A single exacerbation should trigger a look at medication and overall management, Halpin said.

“Accepting any exacerbations is really not good enough,” he said.

Treatment needs to be much more aggressive but realistic, Halpin added, accepting that not all exacerbations may be preventable while still aiming to prevent them all.

What Barriers Limit Optimal Treatment

Halpin described several barriers, including that patients may not understand the disease or recognize how important exacerbations are, and financial pressure may limit their ability to afford medication. For clinicians, time is a challenge, since it takes time to explain the disease and what each treatment does. Treatments also may not produce a large improvement in symptoms, although over the long term they may stabilize disease.

Halpin said a holistic approach is needed.

“It’s not just all about the inhalers,” he said, noting that rehabilitation, vaccination, and smoking cessation are all part of good COPD management.