From the Guidelines
The GOLD 2025 guidelines recommend using pre-bronchodilator spirometry to rule out COPD and post-bronchodilator measurements to confirm the diagnosis, with a post-bronchodilator FEV1/FVC ratio less than 0.7 confirming airflow limitation 1.
Diagnosis of COPD
The diagnosis of COPD should be considered in individuals with chronic respiratory symptoms and/or exposure to risk factors, such as cigarette or biomass smoke exposure 1.
- The testing process should begin with a thorough clinical assessment including smoking history, occupational exposures, and symptom evaluation using validated tools like the COPD Assessment Test (CAT) or Modified Medical Research Council (mMRC) dyspnea scale.
- Spirometry is the gold standard diagnostic test, measuring lung function by assessing the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) 1.
Spirometry Measurements
- Pre-bronchodilator spirometry can be used to rule out COPD, while post-bronchodilator measurements are necessary to confirm the diagnosis 1.
- A post-bronchodilator FEV1/FVC ratio less than 0.7 confirms airflow limitation, which is a key criterion for diagnosing COPD 1.
- Post-bronchodilator results close to the threshold should be repeated to ensure a correct diagnosis is made, and to limit COPD overdiagnosis 1.
Additional Testing
- Additional testing may include chest imaging, exercise capacity tests like the 6-minute walk test, and blood tests including alpha-1 antitrypsin levels in younger patients or those with family history.
- The 2025 guidelines emphasize earlier detection through more widespread screening of at-risk individuals, even those without obvious symptoms, as early intervention can significantly slow disease progression 1.
Monitoring Disease Progression
- The guidelines also recommend periodic reassessment of lung function, typically annually, to monitor disease progression and treatment effectiveness 1.
From the Research
COPD GOLD 2025 Guidelines
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides guidelines for the diagnosis and management of Chronic Obstructive Pulmonary Disease (COPD) [ 2, 3, 4 ].
Diagnosis and Spirometry
Spirometry is the gold standard for diagnosing and monitoring COPD [ 5 ]. The forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) are key parameters used to assess lung function.
Treatment Options
Treatment guidelines recommend the use of inhaled long-acting bronchodilators to alleviate symptoms and reduce the risk of exacerbations [ 2, 3, 4 ].
- Tiotropium, a long-acting anticholinergic, has been shown to be effective in improving lung function and reducing exacerbations [ 2, 3, 4 ].
- Salmeterol, a long-acting beta-agonist, is also used to improve lung function and symptoms [ 2, 3, 6 ].
- Combination therapy of tiotropium and salmeterol has been shown to provide additional benefits in improving lung function and reducing symptoms [ 6 ].
Key Findings
- Tiotropium has been shown to be more effective than salmeterol in preventing exacerbations [ 4 ].
- Combination therapy of tiotropium and salmeterol provides clinically meaningful improvements in airflow obstruction and dyspnea [ 6 ].
- Spirometric indices, such as FEV1 and FVC, are important parameters to assess lung function and monitor disease progression [ 5 ].