A CAPTURE ancillary study to assess GOLD 2025 spirometry recommendations in primary care adults.
Academic Article
Overview
abstract
OBJECTIVE: Assess the impact in primary care of the 2025 Global Obstructive Lung Disease (GOLD) comment to use pre-bronchodilator results when they do not demonstrate obstruction. MATERIALS AND METHODS: Data from participants of the COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation (CAPTURE) study who had baseline pre- and post-bronchodilator (BD) spirometry were used to assess the pre-BD results ability to predict post-BD obstruction, defined as FEV1/FVC <0.70. Spirometry data were stratified into four groups: 1) consistent non-obstruction, 2) only post-BD obstruction-missed diagnosis, 3) consistent obstruction and 4) only pre-BD obstruction-over diagnosed. Sensitivity, specificity, positive and negative predictive value (PPV and NPV) of the pre-BD results to predict post-BD obstruction were calculated. RESULTS: 1,181 of 4,336 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 1,181, 701 (59.4%) had consistent non-obstruction with 26 (2.2%) having only post-BD obstruction-missed diagnosis of COPD by pre-BD, while 273 (23.1%) had consistent obstruction. 181 (15.3% of the 1181 or 4.2% of the 4,336) had only pre-BD obstruction-overdiagnosis of COPD. Pre-BD sensitivity for post-BD obstruction (labelled COPD) was 91.3% (95%CI 87.5-94.2%) with specificity 79.5% (95%CI 76.7-82.1%), NPV 96.4% (95%CI 94.8-97.7%) and PPV 60.1% (95%CI 55.5-64.7%). CONCLUSIONS: Using the 2025 GOLD 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 non-obstructive pre-BD results may be used routinely in primary care.
