Abstract: Building on the established framework for the diagnosis, treatment, management, and prevention of chronic obstructive pulmonary disease (COPD), the 2026 report of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides systematic updates to key aspects including disease burden, case finding, risk stratification, maintenance treatment, acute exacerbation management, comorbidity evaluation, and the application of emerging technologies. This revision further highlights the importance of early identification, acute exacerbation prevention, and longterm dynamic assessment in COPD care; clearly differentiates screening from case finding and underscores proactive case identification in individuals with symptoms and/or risk factor exposure; defines the occurrence of one or more moderate or severe acute exacerbations within the previous year as a criterion for Group E assignment, thereby reinforcing the central role of acute exacerbations in risk stratification and therapeutic decisionmaking; and introduces for the first time the concept of “disease activity”, proposing a low disease activity state, defined by the absence of acute exacerbations, no symptomatic deterioration, and no accelerated decline in lung function, as a major management goal. The guideline also clarifies distinct decision pathways for initial and followup treatment, strengthens precise evaluation and individualized intervention during acute exacerbations, and advances comorbidity assessment from a singledisease focus to an integrated multimorbidity management paradigm. Collectively, GOLD 2026 places greater emphasis on early intervention and acute exacerbation prevention in COPD management, carrying important implications for optimizing early diagnosis and treatment as well as longterm standardized management of COPD in China.

Key words: Chronic obstructive pulmonary disease, Exacerbations, Disease activity, Guideline, COPD

摘要： 慢性阻塞性肺疾病（简称慢阻肺病）全球倡议（GOLD）2026指南在延续慢阻肺病诊断、治疗、管理及预防基本框架的基础上，对疾病负担、病例发现、风险分层、维持期治疗、急性加重管理、合并症评估及新兴技术应用等方面进行了系统更新。本次更新进一步突出了慢阻肺病管理中早期识别、急性加重预防及长期动态评估的重要性，明确区分了筛查与病例发现，强调在有症状和/或有危险因素暴露人群中主动开展病例发现。将过去1年发生≥1次中度或重度急性加重列为E组判定标准，进一步强化了急性加重在风险分层和治疗决策中的核心地位。首次引入“疾病活动度”概念，并提出以无急性加重、无症状恶化和无肺功能加速下降为特征的低疾病活动状态作为重要管理目标。指南同时进一步明确了初始治疗与随访期治疗的不同决策路径，强化了急性加重期的精准评估与个体化干预，并推动合并症评估由单病种视角向多病种综合管理的转变。总体而言，GOLD2026指南进一步强调了慢阻肺病管理关口前移和急性加重预防，对优化我国慢阻肺病早诊早治和长期规范化管理具有重要意义。

关键词: 慢性阻塞性肺疾病, 急性加重, 疾病活动度, 指南, COPD