Update 2025 of the Spanish COPD Guidelines (GesEPOC): Pharmacological Treatment of Stable COPD

• Marc Miravitlles ^[7] ; Myriam Calle ^[1] ; Jesús Molina ^[8] ; Pere Almagro ^[9] ; José-Tomás Gómez ^[10] ; Juan Antonio Trigueros ^[11] ; Efraín Sánchez-Angarita ^[12] ; Borja G. Cosío ^[13] ; Ciro Casanova ^[14] ; José Luis López-Campos ^[2] ; Juan Antonio Riesco ^[3] ; Pere Simonet ^[15] ; David Rigau ^[16] ; Ainel Iskakova ^[16] ; Mariano Pastor Sanz ^[17] ; Patricia Sobradillo ^[4] ; Bernardino Alcázar-Navarrete ^[5] ; Noé Garin ^[6] ; Juan José Soler-Cataluña ^[18]
  1. [1] Instituto de Investigación Sanitaria del Hospital Clínico San Carlos

     Instituto de Investigación Sanitaria del Hospital Clínico San Carlos

     Madrid, España

     
  2. [2] Hospital Universitario Virgen del Rocío

     Hospital Universitario Virgen del Rocío

     Sevilla, España

     
  3. [3] Hospital San Pedro de Alcántara

     Hospital San Pedro de Alcántara

     Cáceres, España

     
  4. [4] Hospital Universitario de Cruces

     Hospital Universitario de Cruces

     Barakaldo, España

     
  5. [5] Hospital Universitario Virgen de las Nieves

     Hospital Universitario Virgen de las Nieves

     Granada, España

     
  6. [6] Hospital de la Santa Creu i Sant Pau

     Hospital de la Santa Creu i Sant Pau

     Barcelona, España

     
  7. [7] Servicio de Neumología, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, España
  8. [8] Centro de Salud Francia, Dirección Asistencial Oeste, Grupo de Respiratorio de semFYC, Madrid, España
  9. [9] Servicio de Medicina Interna, Hospital Universitario Mutua de Terrassa, España
  10. [10] Centro de Salud de Nájera, La Rioja, España
  11. [11] Centro de Salud de Buenavista, Toledo, España
  12. [12] Servicio de Neumología, Omni Hospital Guayaquil, Guayas, Ecuador, Departamento de EPOC Asociación Latinoamericana del Tórax (ALAT), España
  13. [13] Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, España
  14. [14] Servicio de Neumología-Unidad de Investigación Hospital Universitario Nuestra Señora de La Candelaria, Universidad de La Laguna, Tenerife, España
  15. [15] Centro de Salud Viladecans-2, Gerència d’Atenció Primària i a la Comunitat Delta-Institut Català de la Salut, Barcelona, España
  16. [16] Asociación Colaboración Cochrane Iberoamérica (ACCIb), Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, España
  17. [17] Presidente de la Federación Española de Asociaciones de Pacientes Alérgicos y con Enfermedades Respiratorias (FENAER) y vocal de la Junta Directiva del Foro Español de Pacientes (FEP), España
  18. [18] Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Departamento de Medicina, Universidad de Valencia, Valencia, España

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• Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 61, Nº. 12 (December 2025), 2025, págs. 766-782
• Idioma: inglés
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• Resumen

  • The Spanish COPD Guidelines (GesEPOC) were first published in 2012, and since then, several updates have incorporated new evidence regarding the diagnosis and treatment of COPD. GesEPOC is a clinical practice guideline developed with the collaboration of the scientific societies involved in COPD management and the Spanish Patients’ Forum. Its recommendations are based on an evaluation of the evidence using the GRADE methodology and on a narrative description of the evidence in those areas where application of this methodology is not feasible.

    This article summarizes the updated recommendations on the pharmacological treatment of stable COPD, derived from the development of 12 PICO questions. The COPD treatment process comprises five stages: (1) diagnosis; (2) risk stratification; (3) characterization; (4) initiation and continuation of treatment; and (5) follow-up. For inhaled treatment selection, high-risk patients are classified into three phenotypes: non-exacerbator, eosinophilic exacerbator, and non-eosinophilic exacerbator. Treatable traits include general aspects, applicable to all patients—such as smoking cessation and inhaler technique—and more specific conditions, mainly affecting severe patients, such as chronic hypoxemia or chronic bronchial infection.

    The cornerstone of COPD treatment is long-acting bronchodilators, either as monotherapy or in combination, depending on the patient's risk level. Eosinophilic exacerbators should receive inhaled corticosteroids, whereas non-eosinophilic exacerbators require a detailed evaluation to identify the most appropriate therapeutic option. GesEPOC 2025 also includes recommendations on inhaled corticosteroid withdrawal, the introduction of biologics, and the indication for alpha-1 antitrypsin therapy. GesEPOC 2025 represents a more individualized approach to COPD treatment, tailored to the clinical characteristics of patients and their level of risk or complexity.