GOLD 2025 in practice: Enhancing COPD diagnosis in primary care with effective spirometry

Accurate and accessible diagnosis is central to improving outcomes for patients with chronic obstructive pulmonary disease (COPD). A recent study published in Annals of the American Thoracic Society explores how updated GOLD 2025 recommendations can simplify and strengthen spirometry use in primary care, ultimately enabling earlier identification and better management of respiratory disease.

Spirometry remains the gold standard for diagnosing COPD, yet access to full testing, particularly post-bronchodilator (post-BD) assessment, can be challenging in busy primary care settings. The GOLD 2025 guidance addresses this by recommending that if pre-bronchodilator (pre-BD) spirometry shows no obstruction (FEV₁/FVC ≥0.70), post-BD testing may not be necessary unless clinical suspicion is high. This study evaluated the real-world impact of that recommendation, using data from over 1,100 primary care patients.

The findings are compelling. Pre-BD spirometry demonstrated a high sensitivity (91.3%) and an excellent negative predictive value (96.4%) in identifying patients without airflow obstruction. This means that when pre-BD results are normal, clinicians can be confident that COPD is unlikely, reducing the need for additional testing. Importantly, the rate of missed COPD diagnoses when relying on pre-BD results alone was very low, affecting just 2.2% of patients in the study group.

These insights have significant implications for patient care. By streamlining spirometry workflows, more practices can implement routine lung function testing, supporting earlier diagnosis and intervention. Earlier detection allows for timely treatment, lifestyle changes such as smoking cessation, and ongoing monitoring, all of which are proven to improve long-term outcomes.

The study also highlights the importance of identifying patients with intermediate or evolving conditions, such as preserved ratio impaired spirometry (PRISm). Many individuals in this category experience symptoms and are at risk of progression to COPD, reinforcing the importance of spirometry as a tool not only for diagnosis but for ongoing risk assessment and patient monitoring.

For healthcare providers, the message is clear: high-quality spirometry, especially when accessible at the point of care, plays a critical role in delivering better respiratory health outcomes. By adopting simplified, evidence-based approaches, clinicians can increase testing uptake, improve diagnostic accuracy, and ensure that more patients receive the care they need, sooner.

References: 

Yawn BP, Angulo D, Joo M, et al. A CAPTURE ancillary study to assess GOLD 2025 spirometry recommendations in primary care adults. Annals of the American Thoracic Society. 2026;23(6):873–883. https://doi.org/10.1093/annalsats/aaoag020