Chronic obstructive

pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory condition that causes reduced airflow and breathing difficulties.^2,6 COPD is characterised by chronic bronchitis and/or pulmonary emphysema.^1,6 Various processes can cause the airways to narrow: damage to certain parts of the lungs, mucus blocking the airways and/or inflammation and swelling of the airway lining.²

COPD develops slowly over time, with smoking and air pollution being the most common causes.² One in two smokers over the age of 40 suffers from chronic bronchitis.¹ People with COPD are at increased risk of developing other health problems.²

COPD is the third leading cause of death worldwide and accounts for more than 3 million deaths each year.²

Possible consequences of COPD include:¹

• Heart failure
• Various other heart conditions
• Pulmonary failure
• Isolation and depression resulting from severely reduced functional capacity

COPD is characterised by the occurrence of exacerbations, i.e. sudden worsening of COPD symptoms that require additional treatment and contribute to the progression of the disease.⁷ Exacerbations are associated with an accelerated loss of lung function and a lasting impairment of quality of life.⁸

Furthermore, a moderate exacerbation has been associated with a significant increase in the risk of severe cardiovascular events within the first 30 days.⁹ Severe exacerbations have even been linked to an increased risk of secondary cardiovascular events for up to one year.⁹ Furthermore, cardiopulmonary causes are the leading cause of death in patients
with COPD.¹⁰

The GOLD classification of COPD describes the severity of airway obstruction and disease activity. It is used internationally and is also recommended by the SGP.^6,11

The GOLD-ABE classification categorises patients according to their symptom burden and risk of exacerbation. Symptoms are assessed using standardised scores (mMRC or CAT), and the risk of exacerbation is determined on the basis of medical history. This enables targeted and individualised treatment planning.^{15, 16}

In Switzerland, COPD generally presents as exertional dyspnoea, a chronic cough and sputum production, as well as exacerbations that significantly impair the daily lives and quality of life of those affected.^1,3,11

According to the GOLD guidelines, a COPD screening assessment should be carried out from around the age of 35 in people with significant exposure (e.g. tobacco smoke, indoor/outdoor air pollution, occupational exposure) and/or respiratory symptoms.⁶ In particular, spirometry to screen for COPD should be carried out in people over the age of 40 with a smoking history of at least 10 pack-years and who have at least one key symptom (phlegm, cough or shortness of breath).¹¹

Spirometry is the gold standard for confirming a diagnosis of COPD. The key diagnostic criterion is a FEV₁/FVC ratio < 0.7 following bronchodilation, which indicates airway obstruction that is not fully reversible. Spirometry is an objective and easily reproducible method; it should be performed in all patients in whom COPD is suspected.^6,11

In addition to confirming the diagnosis, spirometry enables the degree of airway obstruction to be classified according to the four GOLD stages (GOLD 1 to 4).⁶

This spirometric classification is used primarily to assess prognosis and only partially reflects the clinical burden of the disease.⁶

Imaging techniques (such as CT scans or X-rays) are used for differential diagnosis and to rule out other possible causes, but do not replace spirometry.⁶

To assess the severity of COPD and determine the optimal treatment, a comprehensive approach is required that takes into account several clinical dimensions. In this regard, functional limitations, clinical symptoms, disease activity and relevant associated factors must be considered together.^6,11

The following aspects should be taken into account in the initial assessment:⁶

• Functional severity of airway obstruction: assessed by spirometry (FEV₁/FVC > 0.7 after bronchodilation)
• Clinical symptom burden: assessed in a standardised manner, for example using the COPD Assessment Test (CAT) or the mMRC dyspnoea score^15,16
  
  • Download the CAT questionnaire
  • Download the mMRC questionnaire
• History of moderate and severe exacerbations as markers of disease activity
• Smoking as a key risk factor and a lever for preventive measures
• Blood eosinophil count (EOS) as a supporting biomarker for treatment decisions
• Screening for α₁-antitrypsin deficiency, a potential genetic cause of COPD
• Associated conditions, particularly cardiovascular, metabolic and mental health comorbidities

The combination of symptom burden and history of exacerbations enables the GOLD group to be determined, which facilitates the practical classification of patients into treatment groups. The GOLD-ABE classification, based on symptoms and exacerbations, now forms the basis for treatment decisions.⁶

Regardless of the initial classification, it is recommended that a structured and regular reassessment of symptoms, exacerbations and response to treatment be carried out throughout the course of the disease, as the clinical situation and therapeutic needs may change over time.^6,11

Modern treatment of COPD is based on the GOLD guidelines and is supplemented by the Swiss Lung Association’s pocket guide to COPD. It is based on the use of inhaled bronchodilators as first-line treatment, with individualised adjustment of the inhalation regimen for COPD, targeted escalation up to triple inhaled therapy, as well as complementary measures such as oxygen therapy for COPD and the early integration of pulmonary rehabilitation – depending on the severity, symptom burden and risk of exacerbation.^6,11

Pharmacological treatment of COPD relies primarily on the inhalation of bronchodilators. Short-acting β₂-agonists (SABAs) and short-acting muscarinic antagonists (SAMAs) are used as and when required to provide rapid symptom relief. For maintenance treatment, long-acting β₂-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) form the basis of treatment.^6,11

Pharmacological treatment of COPD relies primarily on inhaled bronchodilator therapy. Short-acting β₂-agonists (SABAs) and short-acting muscarinic antagonists (SAMAs) are used as ‘as-needed’ medications for rapid symptom relief. For maintenance treatment, long-acting β₂-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) form the basis of drug therapy.^6,11

New in GOLD 2026:

Already ≥ 1 moderate exacerbation → group E⁶

Inhaled corticosteroids (ICS) are not routinely indicated, but should be used selectively in patients with frequent exacerbations and eosinophilia.¹¹

Escalation of treatment in the event of persistent exacerbations:

• Roflumilast may be considered in cases of persistent exacerbations despite optimised inhaled therapy in patients with severe airway obstruction and chronic bronchitis.⁶
• Azithromycin may be used, particularly in former smokers, to reduce the rate of exacerbations.⁶
• If exacerbations persist despite optimised inhaled treatment (including triple therapy in accordance with the GOLD treatment escalation guidelines), broader treatment options such as biologics (e.g. dupilumab or mepolizumab) may be considered.^6,11

Inhalation is the preferred route of administration in COPD, as it allows for targeted action in the airways whilst limiting systemic exposure. Therapeutic success depends not only on the active ingredient, but also, and above all, on the inhalation device and its correct use.⁶

Available inhalation systems:⁶

The choice must be made on a case-by-case basis, taking into account factors such as inspiratory flow rate, coordination, cognitive abilities and patient preferences. Structured training in inhalation technique, as well as regular monitoring of this technique, form an integral part of therapeutic follow-up.⁶

Long-term oxygen therapy is indicated, in cases of stable COPD, exclusively in patients with severe chronic hypoxaemia. The primary aim is not to relieve symptoms, but to improve the prognosis. In patients without significant resting hypoxaemia, oxygen therapy is not routinely recommended. The indication must be established on the basis of objective measurements and reassessed regularly.⁶

Pulmonary rehabilitation is a central component of non-pharmacological treatment for COPD and is recommended for patients, regardless of the severity of their disease, who have a significant symptom burden or an increased risk of exacerbation. It comprises physical training, respiratory therapy, patient education and psychosocial support. Evidence shows that rehabilitation improves exercise capacity, alleviates dyspnoea and enhances quality of life, whilst reducing the risk of subsequent events and hospitalisations, particularly following exacerbations. It is recommended that rehabilitation be incorporated from the outset of the treatment plan and assessed regularly, as its effects are independent of the severity determined by spirometry.⁶

Motivation to stop smoking: giving up smoking is the most effective individual measure for slowing the progression of COPD.^6,11

Vaccinations: to reduce COPD exacerbations, hospitalisations and
mortality, the SGP recommends regular vaccinations, in particular: ¹¹

• Influenza: annually
• SARS-CoV-2: in accordance with the FOPH’s recommendations for at-risk patients
• Pneumococcal: PCV15 or PCV20 (tailored to age and risk profile)
• RSV/herpes zoster: vaccination against RSV and herpes zoster in high-risk elderly patients as well as in certain selected patients.

Furthermore, support with self-management (including monitoring of symptoms, management of medication and decision-making) can improve resilience, quality of life and prognosis. A personalised action plan for managing exacerbations can boost patients’ self-efficacy and enable early detection and treatment of worsening symptoms.¹¹

The management of exacerbations follows a clear protocol, based on the GOLD and SGP guidelines. The aim is to detect acute deterioration early, stabilise the airways rapidly, avoid complications and prevent further exacerbations. A structured assessment helps to determine whether outpatient treatment or hospital management is appropriate.^6,11

Treatment of an exacerbation of COPD is carried out in stages and must be initiated early:^6,11

• Bronchodilation by increasing the dose of short-acting β₂-agonists (SABA) ± anticholinergics (SAMA)
• Systemic corticosteroids
• Antibiotics in cases of purulent sputum, signs of bacterial infection or severe exacerbation
• In the event of respiratory acidosis or hypercapnia, non-invasive ventilation (NIV) should be considered as soon as possible, as it has been shown to reduce the rate of intubation, the length of hospital stay and mortality.
• In some cases, high-flow nasal therapy (HFNT) may also be used.

In cases of mild to moderate COPD exacerbation, outpatient treatment with a follow-up appointment within 48 hours is possible. In cases of severe exacerbation, frequent check-ups are required after 24 to 48 hours.^6,11

Hospitalisation is indicated in the following cases:^6,11

• no clinical improvement
• persistent hypoxaemia
• signs of respiratory failure or significant comorbidities

Following an exacerbation, a structured reassessment is essential.^6,11

This includes:

• optimising and, where necessary, stepping up maintenance inhaled treatment (e.g. dual or triple therapy)
• Checking inhalation technique and adherence to treatment
• the early initiation of pulmonary rehabilitation
• Management of comorbidities and risk factors.

Link to the COPD information sheet