In Brief | Non-Communicable Diseases | COPD
New Study Shows Multidimensional Diagnostic Approach Enhances COPD Identification and Risk Stratification
Time to read: 02:41
Time to listen: 06:57
Originally Published: 18 January 2025
Source: JAMA
Type of article: In Brief
MedED Catalogue Reference: MNC001
Category: Non-Communicable Diseases
Cross Reference:COPD, Respiratory Disease
Keywords: AI, LLM, Epilepsy
This article is a review of recent studies originally published in the JAMA, 15 May 2025. This article does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information.
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Study Context
Chronic obstructive pulmonary disease (COPD) is traditionally diagnosed using spirometric evidence of airflow obstruction. However, it is increasingly recognised that individuals may exhibit significant respiratory morbidity in the absence of classic spirometric findings, often accompanied by structural lung abnormalities visible on imaging and symptomatic burden.
Current diagnostic schemas do not incorporate chest computed tomography (CT) findings or patient-reported respiratory symptoms, potentially underdiagnosing individuals at risk of poor outcomes.
Study Purpose
This study aimed to evaluate whether a revised, multidimensional diagnostic schema for COPD—one that integrates respiratory symptoms, quality of life, spirometry, and CT-defined structural lung disease—can better identify individuals at risk for adverse respiratory outcomes.
Specifically, it sought to determine whether this expanded definition captures additional individuals who traditional diagnostic approaches would otherwise miss.
Study Methodology
This cohort study pooled data from two well-established longitudinal studies: COPDGene (n = 9416 analysed) and CanCOLD (n = 1341 analysed).
Participants were categorised using a new diagnostic schema comprising two categories:
impaired respiratory quality of life).
The outcomes assessed included all-cause mortality, respiratory-specific mortality, frequency of exacerbations, and the rate of FEV1 decline over time.
Findings
Importantly, newly diagnosed individuals had significantly higher all-cause mortality (adjusted HR: 1.98) and respiratory-specific mortality (adjusted HR: 3.58), along with more frequent exacerbations (adjusted IRR: 2.09) and a faster rate of FEV1 decline (−7.7 mL/year).
Those excluded from diagnosis despite spirometric obstruction had outcome profiles similar to individuals without COPD.
These findings were corroborated in the CanCOLD cohort, where reclassified individuals also experienced significantly more exacerbations.
These findings indicate that a more holistic diagnostic strategy for COPD—incorporating imaging findings and clinical symptoms in addition to spirometry—provides a more accurate reflection of disease burden and prognosis. The proposed schema successfully identified a subgroup of patients experiencing significant morbidity and mortality who would have been missed by spirometry alone. At the same time, it correctly excluded individuals with isolated airflow obstruction who lacked other clinical or structural indicators and did not exhibit increased risk.
By integrating spirometric data, symptom assessment, and radiologic evidence, this multidimensional diagnostic framework effectively recognizes patients at heightened risk for adverse respiratory outcomes. This broader and clinically meaningful approach has the potential to improve diagnostic precision and facilitate more tailored management strategies in COPD care
Importance of this study for South Africa
Chronic obstructive pulmonary disease (COPD) is currently the third leading cause of mortality worldwide.1 The World Health Organisation estimates that the burden of non-communicable diseases (NCDs) in South Africa is two to three times higher than in developed countries.2 Local data from both the national level and the Western Cape Province highlight significant mortality rates attributable to circulatory and respiratory diseases.3,4
COPD patients frequently experience exacerbations that often necessitate hospitalization, with half of those hospitalized dying within 3.6 years post-admission.6 The unpredictable nature of COPD—characterised by sudden, life-threatening exacerbations—often results in reactive, ad hoc clinical decisions, which can adversely affect patient outcomes and perpetuate health inequities.
Primary care utilisation focused on comprehensive, person-centred chronic disease management has been shown to improve outcomes and reduce healthcare costs by minimising secondary and tertiary care needs. Incorporating a revised, multidimensional diagnostic schema for COPD, such as found in this study, one that integrates respiratory symptoms, quality of life assessments, spirometry, and CT-defined structural lung disease, offers a promising pathway to earlier and more accurate identification of individuals at risk for adverse respiratory outcomes.
This approach has the potential to enhance clinical management, improve patient prognosis, and alleviate the financial burden on healthcare systems.
References
1. Global Burden of Disease Collaboration Network.Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle W, USA: Institute for Health Metrics and Evaluation (IHME); 2019.
2. Wagner KH, Brath H. A global view on the development of non communicable diseases. Prev Med. 2012;54:S38–41. doi:10.1016/j.ypmed.2011.11.012
3. World Health Organisation. Chronic Obstructive Pulmonary Disease (COPD) fact sheet; 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd).
4. Moore E, Palmer T, Newson R, Majeed A, Quint JK, Soljak MA. Pulmonary rehabilitation as a mechanism to reduce hospitalizations for acute exacerbations of COPD: a systematic review and meta-analysis. Chest. 2016;150(4):837–859. doi:10.1016/j.chest.2016.05.038
5. Mathews G, Johnston B. Palliative and end-of-life care for adults with advanced chronic obstructive pulmonary disease: a rapid review focusing on patient and family caregiver perspectives. Curr Opin Support Palliat Care. 2017;11(4):315–327. doi:10.1097/SPC.0000000000000303
6. Suissa S, Dell’Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012;67(11):957–963. doi:10.1136/thoraxjnl-2011-201518
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