Incorporating Chest CT and Symptoms into COPD Diagnostic Criteria may identify individuals with poor outcomes: JAMA

The main outcomes were all-cause mortality, mortality due to respiratory causes, exacerbations, and annualized FEV1 decline. The analysis examined how the new schema of diagnosis impacted COPD classification and related health outcomes.

Key Findings

• Among 9,416 COPDGene adults, 811 of 5,250 (15.4%) with no airflow obstruction were newly identified with COPD by the minor diagnostic category and 282 of 4,166 (6.8%) with airflow obstruction were reclassified as without COPD.

• Those who were newly identified with COPD had significantly increased all-cause mortality (adjusted hazard ratio [HR], 1.98; 95% CI, 1.67–2.35; P < 0.001) and respiratory-specific mortality (adjusted HR, 3.58; 95% CI, 1.56–8.20; P = 0.003).

• These patients also had a higher number of exacerbations (adjusted incidence rate ratio [IRR], 2.09; 95% CI, 1.79–2.44; P < 0.001) and increased rate of decline in FEV1 (adjusted β = −7.7 mL/y; 95% CI, −13.2 to −2.3; P = 0.006).

• In CanCOLD, the patients reclassified into COPD also had an increased rate of exacerbation (adjusted IRR, 2.09; 95% CI, 1.25–3.51; P < 0.001).

A new schema for the diagnosis of COPD using respiratory symptoms, spirometry, and CT scanning enhanced the recognition of high-risk patients. A refined method may enhance diagnostic accuracy and provide optimal management for at-risk patients.

Reference:

COPDGene 2025 Diagnosis Working Group and CanCOLD Investigators. A Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease. JAMA. Published online May 18, 2025. doi:10.1001/jama.2025.7358