Validation of probable COPD as proposed by the Lancet Commission at a smoking cessation clinic

Abstract

Aims: The recently published recommendations of the Lancet Commission, the presence of respiratory symptoms or exacerbation in risky people, and the COPD assessment test (CAT) score ?10 points could be defined as possible COPD without using computed tomography and spirometry, particularly in low-income countries. We aimed to validate this recommendation by spirometry in patients applying to our smoking cessation clinic. Methods: Subjects aged ?40 years with a smoking history of ?15 pack-years were included in the study. Individuals with known chronic lung diseases, except childhood asthma, were excluded. All participants completed a detailed case report form, including the CAT questionnaire, and underwent spirometry testing. Results: A total of 224 participants, with a mean age of 53.2 ± 8.7 years of which 49.6 % were female, were enrolled in the study. According to the Lancet Commission's definition, 90 participants were identified as having probable COPD. Among these individuals, 21 (23.3 %) were also diagnosed with COPD based on the pre-bronchodilator FEV1/FVC ratio. In contrast, out of the 134 subjects, who did not meet the criteria for probable COPD, 12 (9 %) were diagnosed with COPD (P = 0.003). Conclusion: This study is the first pilot study to validate the probable COPD definition recommended by the Lancet Commission using spirometry. Approximately 25 % of at-risk patients identified as having probable COPD were diagnosed with COPD based on the pre-bronchodilator FEV1/FVC ratio. Future studies are needed to assess the cost-effectiveness of the diagnostic approach outlined in the algorithm proposed by the Lancet Commission. © 2025 Elsevier B.V., All rights reserved.