GOLD Science Committee recommendations for the use of pre- and post-bronchodilator spirometry to diagnose COPD
Post-bronchodilator spirometry to diagnose COPD
GOLD criteria and diagnostic threshold for COPD
The Global initiative for chronic Obstructive Lung Disease (GOLD) report states that the diagnosis of chronic obstructive pulmonary disease (COPD) should be considered in individuals with chronic respiratory symptoms and / or exposure to risk factors.
Forced spirometry demonstrating airflow obstruction after bronchodilation is required to confirm the diagnosis using a threshold of forced expiratory volume in 1 s (FEV1) / forced vital capacity (FVC) ratio<0.7.
This GOLD Science Committee review weighs the evidence for using pre- or post-bronchodilator (BD) spirometry to diagnose COPD.
Comparison of pre- and post-bronchodilator spirometry to diagnose COPD
Diagnostic concordance and impact on COPD prevalence
Cohort studies have shown that pre- and post-BD spirometry give concordant diagnostic results in most cases, although the prevalence of COPD is up to 36% lower with post-BD values.
Flow and volume responders in spirometry
Discordant results may occur in “volume” or “flow” responders. Volume responders have reduced FVC due to gas trapping causing FEV1/ FVC ratio >0.7 pre-BD, but a volume response occurs post-BD with a greater improvement in FVC relative to FEV1 decreasing the ratio to <0.7. Flow responders show a greater FEV1 improvement relative to FVC which may increase FEV1/ FVC from <0.7 pre-BD to >0.7 post-BD; these individuals have an increased likelihood of developing post-BD obstruction during follow up and require monitoring longitudinally.
GOLD 2025 recommendations for post-bronchodilator spirometry
Use of pre- and post-BD spirometry in clinical practice
GOLD 2025 recommends using pre-BD spirometry to rule out COPD and post-BD measurements to confirm the diagnosis. This will reduce clinical workload.
Importance of repeating borderline post-BD values
Post-BD measurements ensure that volume responders are not overlooked and limit COPD overdiagnosis.
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Authors
Dave Singh, Robert Stockley, Antonio Anzueto, Alvar Agusti, Jean Bourbeau, Bartolome R. Celli, Gerard J. Criner, MeiLan K. Han, Fernando J. Martinez, Maria Montes de Oca, Obianuju B. Ozoh, Alberto Papi, Ian Pavord, Nicolas Roche, Sandeep Salvi, Don D. Sin, Thierry Troosters, Jadwiga Wedzicha, Jinping Zheng, Claus Volgelmeier, David Halpin
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Fecha de publicación
Published online 5 December 2024
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