A NEW diagnostic approach for chronic obstructive pulmonary disease (COPD) that includes chest CT imaging and clinical symptoms alongside spirometry has identified individuals with significantly worse respiratory outcomes who would be missed by conventional definitions, according to findings presented from a large multicentre cohort study.
Researchers analysed data from two longitudinal cohorts, the COPDGene study in the USA and the CanCOLD study in Canada, to evaluate a proposed multidimensional diagnostic schema for COPD. This new classification requires either the presence of spirometric airflow obstruction plus one or more clinical or imaging abnormalities, or, in the absence of airflow obstruction, at least three out of five minor criteria: emphysema, bronchial wall thickening on CT, dyspnoea, poor respiratory quality of life, and chronic bronchitis. Participants were followed for outcomes including all-cause and respiratory mortality, frequency of exacerbations, and rate of lung function decline as measured by forced expiratory volume in one second (FEV1).
Among 9,416 adults in the COPDGene cohort (mean age 59.6 years, 53.5% male), the new diagnostic schema reclassified 15.4% of participants without airflow obstruction (811 of 5250) as having COPD and excluded 6.8% (282 of 4166) who had airflow obstruction but no clinical or imaging abnormalities. Reclassified individuals showed substantially worse outcomes, including nearly double the risk of all-cause mortality (adjusted hazard ratio (aHR): 1.98, 95% CI: 1.67–2.35; P<0.001), a more than threefold increase in respiratory-specific mortality (aHR: 3.58, 95% CI: 1.56–8.20; P=0.003), and more frequent exacerbations (adjusted incidence rate ratio [IRR]: 2.09, 95% CI: 1.79–2.44; P<0.001). These individuals also had a more rapid decline in FEV1 (adjusted β = -7.7 mL/year; 95% CI: -13.2 to -2.3; P=0.006). Results were consistent in the CanCOLD cohort, where newly classified individuals also experienced significantly more exacerbations (adjusted IRR: 2.09, 95% CI: 1.25–3.51; P<0.001).
The study suggests that including imaging and symptom-based data in COPD diagnosis captures patients with high-risk disease who would otherwise be overlooked by spirometry alone. Clinicians should consider these findings when evaluating patients with symptoms suggestive of COPD but normal spirometric values.
Reference
COPDGene 2025 Diagnosis Working Group and CanCOLD Investigators; Bhatt SP et al. A multidimensional diagnostic approach for chronic obstructive pulmonary disease. JAMA. 2025; DOI:10.1001/jama.2025.7358.
