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

Area of Science:

• Pulmonary Medicine
• Diagnostic Accuracy
• Primary Care Research

Background:

• The Global Obstructive Lung Disease (GOLD) guidelines influence COPD diagnosis and management.
• Accurate spirometry interpretation is crucial for timely diagnosis and appropriate treatment in primary care.
• Evaluating the impact of updated GOLD recommendations on diagnostic accuracy in primary care is essential.

Purpose of the Study:

• To assess the diagnostic impact of the 2025 GOLD recommendations regarding the use of pre-bronchodilator spirometry results in primary care.
• To determine the predictive value of pre-bronchodilator (pre-BD) spirometry for identifying post-bronchodilator (post-BD) obstruction.

Main Methods:

• Utilized data from the CAPTURE study, including pre- and post-BD spirometry from primary care participants.
• Stratified participants into four groups based on obstruction status: consistent non-obstruction, only post-BD obstruction, consistent obstruction, and only pre-BD obstruction.
• Calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of pre-BD results for predicting post-BD obstruction.

Main Results:

• Of 1,181 participants meeting spirometry criteria, 23.1% had consistent obstruction and 15.3% had only pre-BD obstruction (overdiagnosis).
• A small proportion (2.2%) had only post-BD obstruction, indicating a potential missed diagnosis by pre-BD results.
• Pre-BD sensitivity for post-BD obstruction was 91.3%, specificity 79.5%, NPV 96.4%, and PPV 60.1%.

Conclusions:

• Applying the 2025 GOLD recommendations using pre-BD spirometry in primary care leads to minimal missed diagnoses of COPD or obstruction.
• The study supports the routine use of non-obstructive pre-BD spirometry results in primary care settings.
• Pre-BD spirometry demonstrates high accuracy in identifying or ruling out obstruction when interpreted according to the latest GOLD guidelines.