COPD, spirometry, airflow obstruction, FEV1, FVC, FEV1/FVC ratio, GOLD, GLI, COPD diagnosis, lung function, respiratory disease, fixed ratio, LLN, pulmonary function testing, airflow limitation

Spirometry in COPD diagnosis
GOLD and GLI provide a joint position on spirometry for diagnosing COPD, supporting the fixed FEV1/FVC ratio in the appropriate clinical context.

Spirometry in COPD Diagnosis: GOLD and GLI Joint Recommendations

The Role of Spirometry in Confirming COPD

COPD is one of the leading causes of morbidity and mortality worldwide.

Spirometry provides an objective measure of airflow obstruction that, in the appropriate clinical context, confirms the diagnosis of COPD.

However, globally, access to spirometry is limited, the test is under-utilised, and many people are either misdiagnosed or under-diagnosed.

Airflow Obstruction and Diagnostic Thresholds

The intrathoracic airway obstruction that characterises COPD can be detected by finding expiratory flow limitation on spirometry.

A reduced forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio demonstrates flow limitation, but for more than 30 years there has been an unproductive debate about which threshold should be used to define airflow limitation and identify airway obstruction in patients with suspected COPD.

A Practical Approach to COPD Diagnosis

In this viewpoint article, we focus on the use of spirometry use in routine clinical practice to confirm or exclude a diagnosis of COPD, and aim to propose a way forward to end the debate.

GOLD and GLI Consensus on Airflow Obstruction

Harmonising Recommendations for Clinical Practice

GOLD and GLI agree on many issues (box 1). A common goal for both organisations is to reduce barriers to the use of spirometry and make it more available and utilised worldwide (figure 1b). Early recognition of the signs and symptoms of COPD, together with a simple, accurate and consistently used diagnostic test, is essential if we are to reduce the burden of this condition.

Harmonising recommendations, including those of national and regional societies, such as ATS and ERS, is important to remove confusion.

Fixed Ratio for COPD-Related Airflow Obstruction

GOLD and GLI agree that the LLN can be used to identify airflow obstruction more broadly in populations, including younger patients with dyspnoea on exertion, but in the appropriate clinical context (e.g. a symptomatic patient with a medical and exposure history suggestive of COPD), recommend that the fixed ratio is used to identify COPD-related airflow obstruction and confirm a diagnosis of COPD.

Authors

David M.G. Halpin, Sanja Stanojevic, Meredith C. McCormack, Dave Singh, David A. Kaminsky, Claus F. Vogelmeier, Laura Gochicoa-Rangel, Alvar Agusti, Brendan Cooper

Read more details at

European Respiratory Journal (ERJ) – ERS Publications

Fecha de publicación

Published online: 16 April 2026

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