Researchers have found in two longitudinal cohorts that Incorporating chest CT imaging and respiratory symptoms into the diagnostic criteria for chronic obstructive pulmonary disease (COPD) significantly improved the identification of individuals at risk for poor respiratory outcomes. This updated approach categorized 15.4% of individuals without airflow obstruction as having COPD under a minor diagnostic category, as reported by Dr. Surya P. Bhatt at the American Thoracic Society annual meeting in San Francisco. This study was published in JAMA Network.
This research, using data from the Genetic Epidemiology of COPD (COPDGene) and Canadian Cohort Obstructive Lung Disease (CanCOLD), assessed whether this novel strategy enhanced COPD diagnosis and prediction of risk. This is a cohort study using two large longitudinal cohorts: COPDGene (n = 10,305) and CanCOLD (n = 1,561).
Data were obtained from November 2007 to August 2022 for COPDGene and from November 2009 to December 2023 for CanCOLD. The new diagnostic model characterized COPD using two categories: major (airflow obstruction and one of five minor criteria) and minor (at least three of five minor criteria). Minor criteria were emphysema or bronchial wall thickening on CT, dyspnea, poor respiratory quality of life, and chronic bronchitis.
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
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