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

Assess the impact in primary care of the 2025 Global Obstructive Lung Disease comment to use prebronchodilator results when they do not demonstrate obstruction.

Data from participants of the chronic obstructive pulmonary disease (COPD) Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation study who had baseline pre- and postbronchodilator (BD) spirometry were used to assess the pre-BD results ability to predict post-BD obstruction, defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.70. Spirometry data were stratified into 4 groups: (1) consistent nonobstruction, (2) only post-BD obstruction-missed diagnosis, (3) consistent obstruction, and (4) only pre-BD obstruction-over diagnosed. Sensitivity, specificity, and positive and negative predictive values of the pre-BD results to predict post-BD obstruction were calculated.

A total of 1181 of 4336 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 1181, 701 (59.4%) had consistent nonobstruction with 26 (2.2%) having only post-BD obstruction-missed diagnosis of COPD by pre-BD, whereas 273 (23.1%) had consistent obstruction. 181 (15.3% of the 1181 or 4.2% of the 4336) had only pre-BD obstruction-overdiagnosis of COPD. Pre-BD sensitivity for post-BD obstruction (labeled COPD) was 91.3% (95% CI, 87.5-94.2) with specificity 79.5% (95% CI, 76.7-82.1), negative predictive value 96.4% (95% CI, 94.8-97.7), and positive predictive value 60.1% (95% CI, 55.5-64.7).

Using the 2025 Global Obstructive Lung Disease 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 nonobstructive pre-BD results may be used routinely in primary care.