实用医学杂志 ›› 2026, Vol. 42 ›› Issue (4): 541-550.doi: 10.3969/j.issn.1006-5725.2026.04.001

• 指南解读 •    

《GOLD 2026报告》关于慢性阻塞性肺疾病诊断、治疗、管理及预防全球策略更新要点解读

刘升明()   

  1. 暨南大学附属第一医院呼吸与危重症医学科( 广东广州 510630)
  • 收稿日期:2025-12-08 出版日期:2026-02-25 发布日期:2026-02-25
  • 通讯作者: 刘升明 E-mail:tlsm@jnu.edu.cn
  • 作者简介:刘升明,博士,教授,主任医师,博士研究生导师及博士后合作导师。暨南大学附属第一医院呼吸与危重症医学科主任。主要研究方向为慢性阻塞性肺疾病的防治,主持及参与国家级、省部级等课题十余项,发表学术论文一百余篇,其中SCI论文60余篇。主要学术任职:中华医学会呼吸病学分会委员,广东省医学会呼吸病学分会主任委员兼慢阻肺学组组长,中国医师协会呼吸医师分会慢阻肺工作委员会委员,广东省医师协会内科医师分会副主任委员,广东省呼吸内科专业质量控制中心副主任,广东省呼吸与健康学会副会长,中国医药教育协会呼吸病康复专业委员会常委,广东省药学会呼吸用药专家委员会副主任委员,广东省健康管理学会呼吸专业委员会副主任委员,广州市医师协会呼吸医师分会副主任委员等职。 E?mail:tlsm@jnu.edu.cn

Interpretation of key updates of global strategy for the diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease 2026 Report

Shengming LIU()   

  1. Department of Pulmonary and Critical Care Medicine,the First Affiliated Hospital of Jinan University,Guangzhou 510630,Guangdong,China
  • Received:2025-12-08 Online:2026-02-25 Published:2026-02-25
  • Contact: Shengming LIU E-mail:tlsm@jnu.edu.cn

摘要:

《GOLD 2026报告》在慢性阻塞性肺疾病(以下简称慢阻肺病)的诊断、治疗、管理及预防策略方面做出多项关键更新。新版指南首次引入“疾病活动度”概念,明确以低疾病活动度为核心治疗目标。在急性加重风险分层方面,指南将过去1年内发生≥ 1次中重度急性加重即纳入高风险组,强调及早识别与干预的重要性。疫苗策略方面,RSV疫苗接种人群年龄下限扩展至50岁,并新增mRNA疫苗作为可选方案,同时更新了流感疫苗在高危人群中的保护证据。生物制剂治疗部分通过循证图表系统展示其疗效,助力实现精准治疗目标。共病管理章节提出“多病协同”理念,采用4Ms评估框架全面覆盖心血管、呼吸、精神及代谢等多系统共病,并明确了相应治疗建议。此外,指南还正式将人工智能与远程医疗技术纳入诊疗体系。整体来看,此次更新标志着慢阻肺病管理模式向更前瞻、更精准、更整体的方向演进,为临床开展个体化治疗、优化长期管理提供了重要依据。该文旨在系统梳理《GOLD 2026报告》更新要点,为临床实践提供参考与指导。

关键词: 慢性阻塞性肺疾病, 疾病活动度, 急性加重, 生物制剂, 疫苗接种, 共病管理

Abstract:

The GOLD 2026 report presents several significant updates in the diagnosis, treatment, management, and prevention of chronic obstructive pulmonary disease (COPD). For the very first time, this report integrates the concept of “disease activity”, spotlighting low disease activity as a core treatment objective. In terms of exacerbation risk stratification, patients who have experienced one or more moderate-to-severe exacerbations in the past year are categorized as high-risk, underscoring the significance of early detection and intervention. Vaccination strategies have been revised as well: the lower age threshold for respiratory syncytial virus (RSV) vaccination has been lowered to 50 years, an mRNA vaccine option has been introduced, and the evidence backing influenza vaccination in high-risk populations has been reinforced. The section on biologics demonstrates their effectiveness through evidence-based charts, which support precision-targeted therapy. The chapter on comorbidity management introduces the multimorbidity (syndemics concept) and utilizes the 4Ms framework to comprehensively tackle cardiovascular, respiratory, psychiatric, and metabolic comorbidities, along with clear instructions on corresponding interventions. Moreover, the report officially incorporates artificial intelligence and telemedicine into the clinical workflow. Overall, these updates signify a transition in COPD management towards a more proactive, precise, and comprehensive approach, offering crucial guidance for individualized treatment and optimized long-term care. This article intends to systematically summarize the key updates in GOLD 2026 to inform clinical practice.

Key words: chronic obstructive pulmonary disease, disease activity, acute exacerbation, biologics, vaccination, comorbidity management

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