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COPD Update 2026: New findings that are also important for Alpha-1 patients 

The new S2k guideline on the diagnosis and therapy of COPD The guideline has been published and includes several important updates that are also highly relevant for people with alpha-1 antitrypsin deficiency. Developed under the leadership of the German Society for Pneumology and Respiratory Medicine (DGP) by numerous experts, the guideline summarizes the current state of research. Its aim is to enable earlier detection and improved treatment of the disease.

A particular focus is on more precise diagnostics. If COPD is suspected, but a basic lung function test is still unremarkable, further investigation will be conducted. This includes more advanced lung function tests that allow for the early detection of changes. Computed tomography of the chest is also gaining importance, especially when symptoms and test results do not correlate well or when there are frequent deteriorations.

For people with alpha-1 antitrypsin deficiency, it is particularly important that this condition has been given its own chapter in the new guideline for the first time. It is now clearly recommended that all people with COPD should be tested for alpha-1 antitrypsin deficiency at least once in their lives. The reason for this is that this cause often goes undetected, even though it can be treated specifically. Simple blood tests, which can provide additional indications of inflammation, are also receiving more attention.

Another important point is the management of so-called exacerbations, i.e., acute worsenings of the disease. The guideline makes it clear that every worsening should be taken seriously, even if it initially appears mild. Early adjustment of the treatment can help to positively influence the course of the disease.

In addition to medication, other measures also play a significant role. These include, above all, consistently quitting smoking, regular exercise and rehabilitation, as well as recommended vaccinations, for example against influenza, pneumococcus, or RSV. It is also noted that COPD increases the risk of cardiovascular disease, which is why this risk should be taken into account.

Overall, the new guideline demonstrates that early diagnosis and comprehensive treatment are crucial. It offers particularly important insights for people with alpha-1 antitrypsin deficiency, enabling them to better recognize the disease and treat it more effectively.

Further information can be found in the S2k guideline „Specialist diagnostics and therapy of chronic obstructive pulmonary disease (COPD) 2026“, which is available via the AWMF.

This can also be read in the DGP press release.

Regarding the guideline

Guidelines and good medical treatment form an important basis for managing the disease. But what those affected can do themselves is equally crucial. This isn't about traditional self-help groups, but rather a new training tool that helps patients recognize acute exacerbations of COPD early on:

Detecting acute COPD exacerbations earlier: How a simple training tool (called CERT) can help you.

Author: Dr. Rainer Gloeckl, Research Institute for Pulmonary Rehabilitation, Schön Clinic Berchtesgadener Land, Schönau am Königssee

Many people with alpha-1 deficiency are familiar with the fear of a sudden worsening of their condition, known as an exacerbation. However, action is often only taken when it is already too late. A new study now shows that with the right tool, the CERT questionnaire, these crises can be recognized before they fully manifest.

When you suddenly can't breathe: Many people don't contact a doctor, or contact them too late. 

An exacerbation is an acute crisis for your lungs. Shortness of breath increases, the cough becomes more troublesome, and your physical capacity drops rapidly. However, the main problem is not only the event itself, but also the timing of seeking medical help.

Perhaps you're familiar with this: It's easy to downplay the first signs. "It's just an off day" or "It's probably just the weather." Studies show that more than half of all acute exacerbations in people with COPD are never reported to their doctor. But if you wait too long, you risk a lot. Every severe exacerbation can permanently damage your lung function and significantly extend your recovery time. Generally, the earlier medication is started, the less severe the crisis will be.

What exactly is the CERT? 

To help you perceive changes in your body more objectively, the CERT (COPD Exacerbation Recognition Tool) was developed (Figure 1). It is a simple, practical training tool specifically designed to improve communication between you and your doctor.

CERT (COPD Exacerbation Recognition Tool)

If you at least have selected 2 points in red, you are likely experiencing a worsening of your COPD, and you should see your doctor. 

Figure 1. The CERT training tool

Instead of relying on complicated medical tests, the CERT focuses precisely where it matters: on what you yourself feel. The CERT helps you ask yourself targeted questions about the worsening of your symptoms. Crucially, you choose the description that best describes your current situation compared to your usual one, specifically regarding the following five symptoms:

1. Worsening cough
2. Increased ejaculation
3. shortness of breath
4. Difficulty breathing
5. Limited physical activity

When should I fill out the CERT form and what does my result mean?

You should complete the CERT if you believe your symptoms have worsened. If at least two of the five listed symptoms have worsened to "moderate" or "severe" (i.e., "in the red zone"), you are likely experiencing an acute exacerbation of your COPD and should consult a doctor. Even if you feel significantly worse than usual, but only one or none of the symptoms have worsened to "moderate" or "severe," you should still see a doctor.

New study shows: Gain a one-day advantage with CERT

Why is this simple training tool so valuable to you? A recent study (Gloeckl et al., 2025) impressively demonstrated the effectiveness of the CERT. With the CERT, signs of deterioration were detected, on average, a full day before a clinical diagnosis by a physician. This extra day is crucial for you. It can determine whether a minor adjustment to your medication at home is sufficient or whether you need to be hospitalized.

Where can you find the CERT?

The CERT is recognized worldwide and easily accessible for you.

• CERT Download: On the GAAPP homepage The CERT is available to you in many different languages as free download available.
• Online check: In Germany, the Lung Information Service offers an interactive online version that allows you to check your symptoms directly on your computer or smartphone. To the interactive CERT tool!
• Video tip: Would you like to know more about the background? Feel free to take a look at this. YouTube video about the CERT from the series „Pneumo4Coffee2Go“ on.

Sources:

• Gloeckl R, Jones PW, Kroll D, Jarosch I, Schneeberger T, Claussen J, Schmidt P, Vogelmeier CF, Kenn K, Koczulla AR. Can Patient Education Lead the Way? Head-To-Head Comparison of EXACT and CERT for Early Recognition of Acute COPD Exacerbations. Respirology. 2025 Nov 30. doi: 10.1002/resp.70170. Online ahead of print
• Gloeckl R, Tal-Singer R, Deussen P, Winwood R, Mohan T, Turner M, Hamouda M, Moore M, Jones P. CERT (COPD Exacerbation Recognition Tool): Translation, cross-cultural and linguistic validation. COPD. 2026 in press

Research: New findings on COPD

All good things come in threes, so we have something else from the Research on COPD, The following research we would like to report on: Researchers at Philipps University of Marburg have discovered why the chronic lung disease COPD often suddenly worsens significantly during a flu infection. The focus is on a messenger substance called CXCL11, which is produced in increased amounts during infection and disrupts the balance of the airways.

The intriguing aspect is that CXCL11 causes increased production of thick mucus while simultaneously weakening the body's natural defenses against viruses. This combination can explain why COPD so often leads to a so-called "downward spiral." An infection results in more mucus, which further constricts the airways. This makes coughing more difficult, pathogens remain in the lungs longer, and trigger further inflammation—the symptoms worsen continuously.

The findings of the research group led by Prof. Mareike Lehmann and Prof. Bernd Schmeck, published in the journal Thorax, are so important because they could provide a new approach for future treatments. If it becomes possible to specifically influence this mechanism, such deterioration could potentially be slowed down or even prevented at an early stage.

For patients, this means that a better understanding of the disease brings research a step closer to new therapies that could help avoid acute deteriorations and improve quality of life in the long term.

Regarding the report

Briefly noted: Further interesting information 

In keeping with the topic of the newsletter, we would like to address the Reminder: Webinar series on topics related to COPD. The next webinar „This constant phlegm – What role does phlegm (or mucus?) play in the respiratory tract and how can I deal with it?“ takes place on April 29, 2026 at 5:00 PM with Dr. Pontus Mertsch, LMU Clinic of the Ludwig Maximilian University of Munich.

And at June 24, 2026 at 5:00 PM then "„COPD safely under control: Recognize warning signs, stay active“Presented by Dr. Rainer Glöckl, Schön Klinik Berchtesgadener Land. The topic is the same as mentioned earlier in the newsletter: "How you can use the CERT questionnaire to intercept crises early and regain more energy for everyday life through targeted training."„

To register