Looking Beyond the Lungs in COPD Care, With Gerard Criner, MD

The 2027 GOLD Report, presented at the Global Initiative for Obstructive Lung Disease (GOLD) 2026 COPD International Conference in Philadelphia, adds more on the evidence and importance of mucus plugs in COPD.

Gerard Criner, MD, chair and professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University and director of the Temple Lung Center, discussed mucus plugging, multimorbidity, and exacerbation risk in an interview with HCPLive at the meeting.

Criner moderated sessions on clinician education, covering inhaler technique, GOLD-guided assessment, and the use of oxygen, noninvasive ventilation, and high-flow nasal therapy in acute and chronic settings. He also moderated a plenary session on mucus plugs. Other sessions at the meeting examined mucus plug reduction with type 2 biologics and the updates in the 2027 GOLD Report.

“I think the most important things currently being talked about here are, first, the assessment of patients’ comorbid states and the multimorbidity they have, and to make people aware of the importance of being more global in their perspective of how COPD affects the patient, rather than just the lung,” Criner said.

Criner also pointed to the risk carried by a single moderate exacerbation. In the EXACOS-CV US cohort study, which Criner coauthored, a moderate exacerbation was associated with a higher 30-day risk of cardiovascular events (moderate HR=1.23 (95% CI 1.12— 1.35)) and death (moderate HR=1.22, 95% CI=1.04— 1.43).¹ He said the goal of therapy should be to capture the overall health, activity, and stability of the patient’s condition, rather than focusing on exacerbations alone.

Mucus plugging carries its own mortality signal. In a COPDGene analysis of 4363 participants published in JAMA, mortality reached 54.1 percent for patients with plugs in three or more lung segments, compared with 34 percent for patients with no detectable plugs.² Criner cited tozorakimab, an investigational anti-IL-33 monoclonal antibody not yet licensed for COPD, as 1 agent shown to reduce mucus plugging.

Looking ahead, Criner said much of what was discussed at the meeting will be incorporated into the 2027 GOLD Report. The aim, he said, is to take findings from the conference and the current literature and distill them into clinical guidance for clinicians caring for patients with COPD.

Editor’s Note: This Q&A transcript has been edited for grammar and clarity using artificial intelligence tools. Criner had no relevant financial disclosures of note.

References

1. Daniels K, Lanes S, Tave A, et al. Risk of death and cardiovascular events following an exacerbation of COPD: the EXACOS-CV US study. Int J Chron Obstruct Pulmon Dis. 2024;19:225-241. doi:10.2147/COPD.S438893.

2. Diaz AA, Orejas JL, Grumley S, et al. Airway-occluding mucus plugs and mortality in patients with chronic obstructive pulmonary disease. JAMA. 2023;329(21):1832-1839. doi:10.1001/jama.2023.2065.