Clinical Validation of a Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease in Chinese

Fan Wu; Suyin Huang; Kunning Zhou; Tingting Xia; Qi Wan; Gaoying Tang; Zhishan Deng; Youlan Zheng; Ningning Zhao; Heshen Tian; Cuiqiong Dai; Lifei Lu; Xiaohui Wu; Zihui Wang; Xiaoyan Huang; Xiaohuan Pan; Jian Zhang; Xianliang Zeng; Zhifeng Gao; Changli Yang; Shengtang Chen; Yongqing Huang; Shuqing Yu; Erkang Yi; Yu Deng; Surya P Bhatt; Yumin Zhou; Pixin Ran; ECOPD Study Investigators

doi:10.1016/j.chest.2025.10.002

Clinical Validation of a Multidimensional Diagnostic Approach for Chronic Obstructive Pulmonary Disease in Chinese

Chest. 2025 Oct 10:S0012-3692(25)05506-0. doi: 10.1016/j.chest.2025.10.002. Online ahead of print.

Authors

Fan Wu¹, Suyin Huang¹, Kunning Zhou², Tingting Xia³, Qi Wan¹, Gaoying Tang², Zhishan Deng², Youlan Zheng⁴, Ningning Zhao², Heshen Tian⁵, Cuiqiong Dai², Lifei Lu², Xiaohui Wu², Zihui Wang², Xiaoyan Huang³, Xiaohuan Pan³, Jian Zhang³, Xianliang Zeng², Zhifeng Gao⁶, Changli Yang⁷, Shengtang Chen⁷, Yongqing Huang⁸, Shuqing Yu⁹, Erkang Yi⁴, Yu Deng³, Surya P Bhatt¹⁰, Yumin Zhou¹¹, Pixin Ran¹²; ECOPD Study Investigators

Affiliations

¹ State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China.
² State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
³ Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁴ Guangzhou National Laboratory, Guangzhou, China.
⁵ Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
⁶ Wengyuan County Center for Disease Control and Prevention, Shaoguan, China.
⁷ Wengyuan County People's Hospital, Shaoguan, China.
⁸ Lianping County People's Hospital, Heyuan, China.
⁹ Lianping County People's Hospital, Heyuan, China; Lianping County Second People's Hospital, Heyuan, China.
¹⁰ Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, United States.
¹¹ State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China. Electronic address: zhouyumin410@126.com.
¹² State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China. Electronic address: pxran@gzhmu.edu.cn.

PMID: 41077384
DOI: 10.1016/j.chest.2025.10.002

Abstract

Background: Although spirometry is used to diagnose COPD, a new multidimensional diagnostic schema has been recently proposed to diagnose this disease. However, evidence in Chinese individuals and never smokers is limited.

Research question: Is the new multidimensional diagnostic method for COPD practical in the Chinese population and never smokers?

Study design and methods: We analyzed data from a 3-year, prospective, multicenter, community-based cohort study. The previous diagnostic criterion for COPD was postbronchodilator FEV₁/FVC<0.70. The new multidimensional diagnostic schema includes the major diagnostic category (presence of the major criterion and at least 1 of 5 minor criteria) and minor diagnostic category (presence of least 3 of 5 minor criteria). The main criterion is postbronchodilator FEV₁/FVC<0.70. The minor criteria include emphysema, bronchial wall thickening, dyspnea, poor quality of life, and chronic bronchitis. We conducted subgroup analysis among never smokers.

Results: Among participants without airflow obstruction, 4.8% (55/1140) met the multidimensional diagnostic criteria; 5.8% (53/915) of participants with airflow obstruction did not meet these criteria. Participants with airflow obstruction who were excluded using the multidimensional diagnostic schema for COPD had a risk of exacerbations and annual decline in lung function similar to that in participants diagnosed as normal using both criteria. Participants without airflow obstruction reclassified as having COPD had a higher risk of exacerbations compared with those diagnosed as normal using both criteria. Similar results were found in never smokers.

Interpretation: The new multidimensional diagnostic schema for COPD can exclude individuals with airflow obstruction who have a favorable respiratory prognosis and identify those without airflow obstruction who are at higher risk for exacerbations in Chinese and never smokers.

Keywords: chronic obstructive pulmonary disease; exacerbation; lung function decline; multidimensional diagnostic approach.