The JRS guideline for the management of chronic obstructive pulmonary disease 7th edition 2026

Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality in Japan, with an estimated prevalence of 8.6% among adults over 40 years of age, yet fewer than 10% of affected individuals receive a formal diagnosis. The Japanese Respiratory Society (JRS) published the 7th edition of the JRS Guidelines for the Management of COPD in March 2026, approximately four years after the 6th edition. This article provides a translated summary of the guidelines, focusing on management goals and both stable- and exacerbation-phase management. The 7th edition incorporates several conceptual advances, including formal adoption of the GOLD 2023 etiotype classification, recognition of CT-detected mucus plugging as an independent prognostic factor, and incorporation of cellular senescence as a disease mechanism. Unique characteristics of Japanese patients including lean body composition, lower exacerbation rates and high prevalence of asthma-COPD overlap (ACO) are highlighted as drivers of Japan-specific management strategies. Comorbidity management, particularly cardiovascular risk during and after exacerbations, is elevated to a core management goal. The guidelines retain 15 clinical questions (CQs) from the prior edition and introduces 7 new CQs (CQ16-22), addressing long-term macrolide antibiotics, bronchoscopic lung volume reduction, and comprehensive exacerbation management, including bronchodilators, systemic corticosteroids, antibiotics, and respiratory support. Dupilumab is newly recommended for patients with type 2 inflammation and frequent exacerbations. Evidence grading follows the Minds/GRADE framework. These guidelines provide practical, evidence-based recommendations tailored to the Japanese clinical context, applicable to both respiratory specialists and general practitioners.