Written by Mary Marschner
Spoon Feed
Spirometry alone doesn’t catch all COPD patients. Five new minor criteria were also associated with increased mortality.
For COPD diagnosis, should we re-consider the GOLD standard?
Current diagnostic criteria of COPD are outlined in the GOLD 2024 guidelines and include symptoms and spirometry to confirm obstruction (FEV1/FVC < 0.7) and classify severity. While I love the simplicity, some patients with normal spirometry have COPD, and some don’t have the resources to get spirometry. Considering other ways to diagnose COPD is likely to be helpful.
This multicenter cohort study assessed a multidimensional diagnostic approach for COPD, which integrates spirometry, respiratory symptoms, and CT imaging. Analyzing 9,416 COPDGene and 1,341 CanCOLD participants, they found 5 minor criteria: emphysema and bronchial wall thickening on CT, dyspnea, quality of life score, and chronic bronchitis. With spirometry as a major criterion plus 1 minor criterion, or 3 of 5 minor criteria (must include at least one change on CT), they reclassified 15.4% of individuals without airflow obstruction as having COPD and excluded 6.8% with obstruction but no symptoms or structural lung disease. Newly classified patients had higher all-cause mortality (HR 1.98; 95%CI 1.67–2.35), increased exacerbations (IRR 2.09; 95%CI 1.79–2.44), and accelerated FEV₁ decline (−7.7 mL/year; 95%CI −13.2 to −2.3).
There are a few limitations to this study. The respiratory quality-of-life score is one which I have not used in practice, so I don’t know if it’s reliable. Additionally, I don’t know how variable bronchial wall thickening and emphysema findings from CT are; I suspect it is reliable, but I would like some validation.
How does this change my practice?
There are many patients who don’t have spirometry measurements available or who clinically present like COPD despite normal spirometry. This study is a good start at catching those extra patients who may have a delayed diagnosis or may not get as aggressively treated because they don’t technically have COPD by spirometry criteria. However, the minor criteria used in this study aren’t always available, and they’re variable enough that I struggle to see how this will be easily incorporated into practice.
Source
A Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease. JAMA. 2025 May 18:e257358. doi: 10.1001/jama.2025.7358. Epub ahead of print. PMID: 40382791
