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A CAPTURE ancillary study to assess GOLD 2025 spirometry recommendations in primary care adults

Year: 2026

Type: article

Abstract: OBJECTIVE: Assess the impact in primary care of the 2025 Global Obstructive Lung Disease comment to use prebronchodilator results when they do not demonstrate obstruction. MATERIALS AND METHODS: Data from participants of the chronic obstructive pulmonary disease (COPD) Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation study who had baseline pre- and postbronchodilator (BD) spirometry were used to assess the pre-BD results ability to predict post-BD obstruction, defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.70. Spirometry data were stratified into 4 groups: (1) consistent nonobstruction, (2) only post-BD obstruction-missed diagnosis, (3) consistent obstruction, and (4) only pre-BD obstruction-over diagnosed. Sensitivity, specificity, and positive and negative predictive values of the pre-BD results to predict post-BD obstruction were calculated. RESULTS: A total of 1181 of 4336 participants (27.2%) were included in this study because they met the study's criteria for pre- and post-BD spirometry: pre-BD obstruction (FEV1/FVC <0.70) or FEV1 < 80% predicted. Of the 1181, 701 (59.4%) had consistent nonobstruction with 26 (2.2%) having only post-BD obstruction-missed diagnosis of COPD by pre-BD, whereas 273 (23.1%) had consistent obstruction. 181 (15.3% of the 1181 or 4.2% of the 4336) had only pre-BD obstruction-overdiagnosis of COPD. Pre-BD sensitivity for post-BD obstruction (labeled COPD) was 91.3% (95% CI, 87.5-94.2) with specificity 79.5% (95% CI, 76.7-82.1), negative predictive value 96.4% (95% CI, 94.8-97.7), and positive predictive value 60.1% (95% CI, 55.5-64.7). CONCLUSIONS: Using the 2025 Global Obstructive Lung Disease recommendations in these primary care patients with pre-BD spirometry showing obstruction or an FEV1 < 80% predicted resulted in few missed diagnoses of COPD or obstruction. Our data confirm that nonobstructive pre-BD results may be used routinely in primary care.

Source: Annals of the American Thoracic Society

DOI: 10.1093/annalsats/aaoag020