A Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease

Surya P Bhatt; Ehsan Abadi; Antonio Anzueto; Sandeep Bodduluri; Richard Casaburi; Peter J Castaldi; Michael H Cho; Alejandro P Comellas; Douglas J Conrad; Jeffrey L Curtis; Chandra Dass; Dawn L DeMeo; Mark T Dransfield; Raul San José Estépar; Eric L Flenaugh; Marilyn G Foreman; Spyridon Fortis; Arnav Gupta; MeiLan K Han; Nicola A Hanania; Craig P Hersh; John E Hokanson; Stephen M Humphries; Miranda Kirby; Ken M Kunisaki; Pei Zhi Li; David A Lynch; Neil R MacIntyre; Barry J Make; David M Mannino; Fernando J Martinez; Charlene E McEvoy; Bruce E Miller; Matthew Moll; Arie Nakhmani; John D Jr Newell; Katherine A Pratte; Elizabeth A Regan; Joseph M Reinhardt; Stephen I Rennard; Harry B Rossiter; Matthew J Strand; Rajat Suri; Emily S Wan; Christine H Wendt; Gloria E Westney; Carla G Wilson; Robert A Wise; Kendra A Young; Wan C Tan; Edwin K Silverman; James D Crapo; CanCOLD Investigators; COPDGene 2025 Diagnosis Working Group

doi:10.1001/jama.2025.7358

Back

A Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease

Journal article

Peer reviewed

A Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease

Surya P Bhatt, Ehsan Abadi, Antonio Anzueto, Sandeep Bodduluri, Richard Casaburi, Peter J Castaldi, Michael H Cho, Alejandro P Comellas, Douglas J Conrad, Jeffrey L Curtis, …

JAMA : the journal of the American Medical Association, Vol.333(24), pp.2164-2175

06/24/2025

DOI: 10.1001/jama.2025.7358

PMCID: PMC12086702

PMID: 40382791

Files and links (1)

url

https://escholarship.org/uc/item/86q0z08sView

Open Access

Abstract

Individuals at risk for chronic obstructive pulmonary disease (COPD) but without spirometric airflow obstruction can have respiratory symptoms and structural lung disease on chest computed tomography. Current guidelines recommend COPD diagnostic schemas that do not incorporate imaging abnormalities. To determine whether a multidimensional COPD diagnostic schema that includes respiratory symptoms and computed tomographic imaging abnormalities identifies additional individuals with disease. This cohort study included 2 longitudinal cohorts: the Genetic Epidemiology of COPD (COPDGene), which enrolled 10 305 participants between November 9, 2007, and April 15, 2011, with longitudinal follow-up through August 31, 2022; and the Canadian Cohort Obstructive Lung Disease (CanCOLD), which enrolled 1561 participants between November 26, 2009, and July 15, 2015, with follow-up through December 31, 2023. Exposure included the new multidimensional COPD diagnostic schema, defined by (1) major diagnostic category: presence of the major criterion (airflow obstruction based on postbronchodilator forced expiratory volume in the first second of expiration [FEV1]/forced vital capacity ratio <0.70) and at least 1 of 5 minor criteria (emphysema or bronchial wall thickening on computed tomography, dyspnea, poor respiratory quality of life, and chronic bronchitis); or (2) minor diagnostic category: presence of least 3 of 5 minor criteria (which must include emphysema and bronchial wall thickening for individuals with respiratory symptoms potentially due to other causes). All-cause mortality, respiratory cause-specific mortality, exacerbations, and annualized change in FEV1. Among 9416 adults in COPDGene (mean [SD] age at enrollment, 59.6 [9.0] years; 5035 [53.5%] were men; 3071 [32.6%] were Black; 6345 (67.4%) were White; 4943 [52.5%] currently smoked), 811 of 5250 individuals (15.4%) without airflow obstruction were newly classified as having COPD by minor diagnostic category, and 282 of 4166 individuals (6.8%) with airflow obstruction were classified as not having COPD. Reclassified individuals with a new COPD diagnosis had greater all-cause mortality (adjusted hazard ratio, 1.98; 95% CI, 1.67-2.35; P < .001) and respiratory-specific mortality (adjusted hazard ratio, 3.58; 95% CI, 1.56-8.20; P = .003), more exacerbations (adjusted incidence rate ratio, 2.09; 95% CI, 1.79-2.44; P < .001), and more rapid FEV1 decline (adjusted β = -7.7 mL/y; 95% CI, -13.2 to -2.3; P = .006) compared with individuals classified as not having COPD. Among individuals with airflow obstruction on spirometry, those no longer classified as having COPD based on this new diagnostic schema had outcomes similar to those without airflow obstruction. Among 1341 adults in CanCOLD, individuals newly classified as having COPD experienced more exacerbations (adjusted incidence rate ratio, 2.09; 95% CI, 1.25-3.51; P < .001). A new COPD diagnostic schema integrating respiratory symptoms, respiratory quality of life, spirometry, and structural lung abnormalities on computed tomographic imaging newly classified some individuals as having COPD. These individuals had an increased risk of all-cause and respiratory-related death, frequent exacerbations, and rapid lung function decline compared with individuals classified as not having COPD. Some individuals with airflow obstruction without respiratory symptoms or evidence of structural lung disease were no longer classified as having COPD.

Details

Title: Subtitle: A Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease
Creators: Surya P Bhatt - University of Alabama at Birmingham
Ehsan Abadi - Duke Medical Center
Antonio Anzueto - The University of Texas Health Science Center at San Antonio
Sandeep Bodduluri - University of Alabama at Birmingham
Richard Casaburi - Ronald Reagan UCLA Medical Center
Peter J Castaldi - Brigham and Women's Hospital
Michael H Cho - Brigham and Women's Hospital
Alejandro P Comellas - University of Iowa
Douglas J Conrad - University of California San Diego
Jeffrey L Curtis - VA Ann Arbor Healthcare System
Chandra Dass - Temple University Hospital
Dawn L DeMeo - Brigham and Women's Hospital
Mark T Dransfield - University of Alabama at Birmingham
Raul San José Estépar - Brigham and Women's Hospital
Eric L Flenaugh - Morehouse School of Medicine
Marilyn G Foreman - Morehouse School of Medicine
Spyridon Fortis - University of Iowa
Arnav Gupta - National Jewish Health
MeiLan K Han - University of Michigan
Nicola A Hanania - Baylor College of Medicine
Craig P Hersh - Brigham and Women's Hospital
John E Hokanson - Colorado School of Public Health
Stephen M Humphries - National Jewish Health
Miranda Kirby - Toronto Metropolitan University
Ken M Kunisaki - Minneapolis VA Health Care System
Pei Zhi Li - McGill University Health Centre
David A Lynch - National Jewish Health
Neil R MacIntyre - Duke Medical Center
Barry J Make - National Jewish Health
David M Mannino - COPD Foundation
Fernando J Martinez - University of Massachusetts Chan Medical School
Charlene E McEvoy - HealthPartners
Bruce E Miller - COPD Foundation
Matthew Moll - Brigham and Women's Hospital
Arie Nakhmani - University of Alabama at Birmingham
John D Jr Newell - Department of Radiology, University of Iowa, Iowa City
Katherine A Pratte - National Jewish Health
Elizabeth A Regan - National Jewish Health
Joseph M Reinhardt - University of Iowa
Stephen I Rennard - University of Nebraska Medical Center
Harry B Rossiter - Ronald Reagan UCLA Medical Center
Matthew J Strand - National Jewish Health
Rajat Suri - University of California San Diego
Emily S Wan - Brigham and Women's Hospital
Christine H Wendt - Minneapolis VA Health Care System
Gloria E Westney - Morehouse School of Medicine
Carla G Wilson - National Jewish Health
Robert A Wise - Johns Hopkins University
Kendra A Young - Colorado School of Public Health
Wan C Tan - University of British Columbia
Edwin K Silverman - Brigham and Women's Hospital
James D Crapo - National Jewish Health
CanCOLD Investigators
COPDGene 2025 Diagnosis Working Group
Resource Type: Journal article
Publication Details: JAMA : the journal of the American Medical Association, Vol.333(24), pp.2164-2175
DOI: 10.1001/jama.2025.7358
PMID: 40382791
PMCID: PMC12086702
NLM abbreviation: JAMA
ISSN: 1538-3598
eISSN: 1538-3598
Publisher: AMER MEDICAL ASSOC; CHICAGO
Grant note: NHLBI: R01 HL151421, U01 HL089897, U01 HL089856 NIH: 75N92023D00011 COPD FoundationAstraZenecaBayer PharmaceuticalsBoehringer IngelheimGenentechGSKNovartisPfizerSunovionCanadian Respiratory Research NetworkCanadian Institutes of Health Research: 93326 Respiratory Health Research Network of the Fonds de la Recherche en Sante du QuebecFoundation of the McGill University Health CentreAstraZeneca Canada LtdBoehringer Ingelheim Canada LtdGSK Canada LtdAlmirallMerckNycomedPfizer Canada LtdTheratechnologies
This work was supported by NHLBI R01 HL151421, U01 HL089897, and U01 HL089856 and by NIH contract 75N92023D00011. COPDGene is also supported by the COPD Foundation through contributions made to an industry advisory board that has included AstraZeneca, Bayer Pharmaceuticals, Boehringer Ingelheim, Genentech, GSK, Novartis, Pfizer, and Sunovion. The CanCOLD study has received support from the Canadian Respiratory Research Network, the Canadian Institutes of Health Research (CIHR/Rx&D Collaborative Research Program operating grant 93326), the Respiratory Health Research Network of the Fonds de la Recherche en Sante du Quebec, the Foundation of the McGill University Health Centre, and industry partners, including AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GSK Canada Ltd, Novartis, Almirall, Merck, Nycomed, Pfizer Canada Ltd, and Theratechnologies.
Language: English
Electronic publication date: 05/18/2025
Date published: 06/24/2025
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; Psychiatry; ICTS; Internal Medicine
Record Identifier: 9984823926802771

Metrics

78 Record Views

12 Times Cited - Web of Science