Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death, affecting an estimated 392 million people worldwide and 16 million in the US. Traditionally, diagnosis has relied heavily on lung function tests, but clinicians have increasingly recognized that spirometry alone does not capture the full complexity of this heterogeneous disease. A new diagnostic framework now offers a more comprehensive way to identify patients at risk of poor respiratory outcomes.

Researchers at the University of Alabama at Birmingham (UAB, Birmingham, AL, USA) and collaborators across the US and Canada have developed a multidimensional diagnostic schema for COPD, as reported in the Journal of the American Medical Association. This approach incorporates airflow obstruction on spirometry as the major criterion, supplemented by minor criteria based on chest imaging and respiratory symptoms. Imaging features include emphysema and airway wall thickening, while symptoms such as breathing difficulty, reduced quality of life, and chronic bronchitis are considered.

Under the new framework, a patient must have airflow obstruction and at least one minor criterion or, in the absence of airflow obstruction, at least three of five minor criteria. This design ensures that both structural lung changes and clinical symptoms are captured. The schema reflects how practitioners have already been informally using imaging and symptoms in diagnosis but now provides standardized parameters to operationalize these practices.

The study examined 9,416 participants in a multicenter cohort. Patients newly diagnosed using the schema showed greater all-cause and respiratory-specific mortality, more frequent exacerbations, and faster lung function decline than those classified as not having COPD under the new system. The framework also excluded individuals with airflow obstruction who lacked symptoms or evidence of structural lung disease.

These findings suggest the schema not only identifies additional individuals with high respiratory morbidity but also improves diagnostic accuracy by ruling out lower-risk cases. Experts note that the approach could shift clinical practice by allowing COPD diagnosis even without overt airflow obstruction on spirometry. While it remains to be seen whether treating newly classified patients will improve outcomes, the model establishes a more inclusive, clinically reflective system.

“This new diagnostic schema will likely change the way we diagnose COPD and enable its diagnosis, even in the absence of overt airflow obstruction on spirometry,” said Surya Bhatt, M.D., professor at the UAB. “Whether treating individuals newly diagnosed this way will result in improved outcomes remains to be tested, but practitioners already been using imaging and symptoms to diagnose COPD. This new schema sets some parameters to operationalize this.”

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