Is “normal” spirometry telling the whole story?

^{by Helen Venn, Chief Science and Strategy Officer}

Vitalograph’s Chief Science and Strategy Officer regularly screens the latest respiratory literature, so you don’t have to. We reviewed 51 recent publications. Here is what stood out, and why it matters for the future of respiratory diagnostics.

1. Rethinking what “abnormal” means

For years, spirometry results have been sorted into two boxes: normal or abnormal, with the 5th percentile as the dividing line. Two new papers challenge that binary. Graham and Stanojevic (2026) suggest extreme value analysis could sharpen spirometry interpretation, while Salvi (2026) argues that lung disease may begin well before a patient crosses the traditional threshold. A lively journal exchange on using spirometry to diagnose COPD shows the debate is far from settled (Burney et al., 2026; Halpin and Stanojevic, 2026).

The direction of travel is clear: from a pass/fail verdict toward a measure of risk and probability of impairment. The next advance in diagnostics may come as much from how we interpret lung function data as from how we measure it.

2. Oscillometry steps into the clinic

A UK national survey (Geeves et al., 2026) suggests oscillometry is moving from research tool to early clinical adoption. The barriers are education, standardization, interpretation and funding, not doubts about its clinical value. A companion review by Yao et al. (2026) positions oscillometry as a complement to spirometry, especially where spirometry is difficult or small airway disease matters: severe asthma, COPD and interstitial lung disease (ILD). Dube et al. (2026) add that oscillometry can identify disease progression in ILD. Expect multi-test interpretation to become a core skill for lung function services.

3. From single events to disease trajectories

The NORDSTAR cohort of almost 100,000 adults (Hansen et al., 2026) found that only 4.1% of people with mild-to-moderate asthma progressed to severe asthma within five years. But for those with late-onset eosinophilic asthma, recurrent respiratory infections and exacerbations despite inhaled corticosteroids, that risk rose as high as 30%. An accompanying editorial argues that an exacerbation can be an early signal of a different future (Sumino and Tang, 2026). The study’s own gap, the absence of longitudinal lung function data, shows where objective monitoring could add value.

In COPD, Singh et al. (2026) propose “disease stability” as a more ambitious goal: no moderate or severe exacerbations, no worsening symptoms and no decline in lung function. Patients who achieved stability had substantially lower risks of future exacerbations and death. Treatment success is being redefined (Trinkmann, 2026), and lung function sits at its center.

4. The diagnosis gap hiding in the data

An analysis of COPD mortality across 27 European countries (Gupta et al., 2026) found rates have fallen since 2018. The authors caution, however, that some of the lowest reported rates may reflect under-diagnosis rather than better lung health, in countries where smoking and occupational exposure point to higher risk. Low numbers can be a sign of limited access to diagnostic testing.

Vitalograph in research

Eight recent publications this month cited use of Vitalograph devices, including a study of London’s Ultra Low Emission Zone and children’s lung function growth (Wood et al., 2026), research on small airway dysfunction in bronchiectasis (Chang et al., 2026), and several chronic cough studies using VitaloJAK cough monitoring, among them a randomized trial of low-dose morphine in refractory chronic cough (Al-Sheklly et al., 2026).

Looking ahead

The thread running through this Radar is a shift from snapshots to trajectories. Clinicians and researchers are asking not just “is this result abnormal?” but “where is this patient heading, and how early can we tell?” Answering that will take better interpretation, complementary tests and consistent measurement over time. We will keep watching, and keep reporting back.

References

Abulibdeh, R. et al. (2026) ‘1,357 AI medical devices cleared, 3 actually tested on patient outcomes’, PLOS Digital Health, 5(8), e0001597. https://doi.org/10.1371/journal.pdig.0001597

Al-Sheklly, B.D. et al. (2026) ‘Low-dose morphine and airway sensations in refractory chronic cough: a randomised control trial’, ERJ Open Research, 12(5). https://doi.org/10.1183/23120541.00173-2026

Baylis, S. et al. (2026) ‘Statement of the European Respiratory Society on the tobacco endgame’, European Respiratory Journal, 68(2). https://doi.org/10.1183/13993003.01013-2026

Burney, P. et al. (2026) ‘The use of spirometry to define airflow obstruction and diagnose COPD’, European Respiratory Journal, 68(2). https://doi.org/10.1183/13993003.00966-2026

Chalmers, J.D. et al. (2026) ‘The European Respiratory Society guideline for management of adult bronchiectasis: clinical summary’, Breathe, 22(2), 260001. https://doi.org/10.1183/20734735.0001-2026

Chang, C.H. et al. (2026) ‘Small airway dysfunction in bronchiectasis patients with exercise-induced desaturation’, Therapeutic Advances in Respiratory Disease, 20, 17534666261480885. https://doi.org/10.1177/17534666261480885

Dube, R. et al. (2026) ‘Respiratory oscillometry identifies disease progression in interstitial lung disease’, BMJ Open Respiratory Research, 13(1). https://doi.org/10.1136/bmjresp-2025-003900

Geeves, M.E. et al. (2026) ‘Current use and future potential of oscillometry in UK lung function testing: a national survey’, BMJ Open Respiratory Research, 13(1). https://doi.org/10.1136/bmjresp-2025-003786

Graham, B.L. and Stanojevic, S. (2026) ‘Extreme value analysis has the potential to improve spirometry interpretation’, Thorax, 81(9), pp. 853-858. https://doi.org/10.1136/thorax-2025-223943

Gupta, A. et al. (2026) ‘Mortality trends in chronic obstructive pulmonary disease in 27 countries within Europe from 2011 to 2021’, BMJ Open Respiratory Research, 13(1). https://doi.org/10.1136/bmjresp-2025-003175

Halpin, D.M.G. and Stanojevic, S. (2026) ‘Reply to: The use of spirometry to define airflow obstruction and diagnose COPD’, European Respiratory Journal, 68(2). https://doi.org/10.1183/13993003.01241-2026

Hansen, S. et al. (2026) ‘From mild-to-moderate to severe asthma: risk factors and patient profiles from the NORDSTAR cohort’, American Journal of Respiratory and Critical Care Medicine, 212(9), pp. 1975-1987. https://doi.org/10.1093/ajrccm/aamag242

Manali, E.D. et al. (2026) ‘Pulmonary fibrosis in chILD: bridging the gap’, The Lancet Respiratory Medicine, 14(9), pp. 751–753. https://doi.org/10.1016/S2213-2600(26)00117-7

Salvi, S. (2026) ‘Beyond the 5th percentile: rethinking diagnostic thresholds in pulmonary function testing’, European Respiratory Journal, 68(2). https://doi.org/10.1183/13993003.00662-2026

Singh, D. et al. (2026) ‘Defining disease stability in chronic obstructive pulmonary disease: evidence from phase 3 clinical trials’, American Journal of Respiratory and Critical Care Medicine, 212(9), pp. 2036-2049. https://doi.org/10.1093/ajrccm/aamag292

Sumino, K. and Tang, M. (2026) ‘When an exacerbation signals a different future in nonsevere asthma’, American Journal of Respiratory and Critical Care Medicine, 212(9), pp. 1885–1887. https://doi.org/10.1093/ajrccm/aamag350

Trinkmann, F. (2026) ‘Aim high- stay stable: rethinking treatment success in chronic obstructive pulmonary disease’, American Journal of Respiratory and Critical Care Medicine, 212(9), pp. 1899-1901. https://doi.org/10.1093/ajrccm/aamag351

Wood, H.E. et al. (2026) ‘Impact of the Ultra Low Emission Zone on lung function growth in children in London, UK: a prospective parallel cohort study’, The Lancet Public Health. https://doi.org/10.1183/23120541.01217-2025

Vitalograph Research Radar: October 2026