A NEW study has shown that the Global Lung Initiative (GLI) spirometry thresholds more accurately identify COPD risk phenotypes in older smokers compared to the Global Initiative for Obstructive Lung Disease (GOLD) criteria, which may overestimate disease severity.
The study evaluated 200 smokers aged 60 and older using a modified COPDGene algorithm. Participants were classified into four risk phenotypes: no COPD (A), possible COPD (B and C), and probable COPD (D), based on symptoms and spirometry results.
Using GLI criteria, 18.5% of smokers had no COPD, while 32% were identified with probable COPD (Phenotype D). By contrast, the GOLD criteria classified fewer smokers as healthy (14.5%) and significantly more, 43%, as probable COPD. Notably, eight smokers identified as “probable COPD” by GOLD were reclassified as healthy (Phenotype A) under GLI, and 22 were downgraded to “possible COPD” (Phenotype B).
The findings suggest that GOLD thresholds may overestimate respiratory impairment in older populations, leading to misclassification of mild cases into more severe phenotypes. Researchers emphasised that this could result in unnecessary treatments, exposing patients to potential harm.
The study underscores the need to adopt age-adjusted GLI criteria to ensure accurate COPD diagnosis in elderly smokers. Doing so could help optimise clinical decision-making and prevent overtreatment.
Aleksandra Zurowska, EMJ
Reference
Bohadana A et al. COPD Risk Phenotypes in Older Smokers: Evaluation in GLI- and GOLD-Defined Respiratory Impairment. Lung. 2025;DOI: 10.1007/s00408-024-00757-4.
