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Evidence-Based Strategies for COPD Diagnosis, Management, and Prevention - Episode 6

GOLD 2025 Report: Prebronchodilator Spirometry and Diagnosis of COPD

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Panelists discuss the initial thought that postbronchodilator spirometry would help differentiate chronic obstructive pulmonary disease (COPD) from asthma. However, postbronchodilator spirometry adds time and effort, as well as exposing a patient to short-term medication that may have adverse effects. Guidelines favor a fixed ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC; < 0.7) because of the ratio’s simplicity and is independent of other reference values.

Video content above is prompted by the following:

  • Why is postbronchodilator spirometry no longer recommended in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2025 Report as the first step in confirming a diagnosis of COPD?
    • How do the results of prebronchodilator spirometry further guide a COPD diagnosis?
    • Why do the guidelines favor a fixed FEV1/FVC ratio (<0.7) over a lower limit of normal as a diagnostic criterion for COPD?
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