ArticleRespiratory research2012
"GOLD or lower limit of normal definition? A comparison with expert-based diagnosis of chronic obstructive pulmonary disease in a prospective cohort-study".
Article in Respiratory research, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 6 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
77 citing papers in PubMed, 6 syntheses or guidelines pooled it, 175 citations in OpenAlex.
- Incidence and Risk Factors for Progression from Pre-COPD to COPD: A Systematic Review and Meta‑analysis.International journal of chronic obstructive pulmonary disease · 2026Pooled it
- The Burden of Chronic Obstructive Pulmonary Disease in the US: A Systematic Review of Nationally Representative Health Surveys.International journal of chronic obstructive pulmonary disease · 2026Pooled it
- The global impact of Aspergillus infection on COPD.BMC pulmonary medicine · 2020Pooled it
- Rate of normal lung function decline in ageing adults: a systematic review of prospective cohort studies.BMJ open · 2019Pooled it
- Characterizing undiagnosed chronic obstructive pulmonary disease: a systematic review and meta-analysis.Respiratory research · 2018Pooled it
- Use of expert panels to define the reference standard in diagnostic research: a systematic review of published methods and reporting.PLoS medicine · 2013Pooled it
- Clinical characteristics of patients newly diagnosed with COPD by the fixed ratio and lower limit of normal criteria: a cross-sectional analysis of the TargetCOPD trial.International journal of chronic obstructive pulmonary disease · 2018Trial
- Joint statement from GOLD/GLI regarding the use of spirometry to define airflow obstruction and diagnose COPD.The European respiratory journal · 2026Article
- Smoking-Attributable Burden of Chronic Obstructive Pulmonary Disease from 1990 to 2021: Temporal Trends and Evidence from the Global Burden of Disease Study.International journal of chronic obstructive pulmonary disease · 2026Article
- The association between Planetary Health Diet Index (PHDI) and chronic obstructive pulmonary disease (COPD): the mediating role of dietary inflammatory index (DII).BMC pulmonary medicine · 2025Article
- Beyond the Spirometry: New Diagnostic Modalities in Chronic Obstructive Pulmonary Disease.Tuberculosis and respiratory diseases · 2025Article
- Risk of All-Cause Mortality in Mild Chronic Obstructive Pulmonary Disease: Evidence From the NHANES III and 2007-2012.International journal of chronic obstructive pulmonary disease · 2025Article
- Symptoms of COPD in the absence of airflow obstruction are more indicative of pre-COPD than overdiagnosis.ERJ open research · 2024Article
- Article
- Pulmonary Function Tests: Easy Interpretation in Three Steps.Journal of clinical medicine · 2024Review
- Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis.Journal of clinical medicine · 2023Review
- Airborne Particulate Matter Size and Chronic Obstructive Pulmonary Disease Exacerbations: A Prospective, Risk-Factor Analysis Comparing Global Initiative for Obstructive Lung Disease 3 and 4 Categories.Journal of personalized medicine · 2023Article
- The Role of Pulmonary Function Testing in the Diagnosis and Management of COPD.Respiratory care · 2023Review
- Understanding COPD Etiology, Pathophysiology, and Definition.Respiratory care · 2023Article
- Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary.The European respiratory journal · 2023Article
17 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Global initiative for chronic Obstructive Lung Disease (GOLD) defines COPD as a fixed post-bronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) below 0.7. Age-dependent cut-off values below the lower fifth percentile (LLN) of this ratio derived from the general population have been proposed as an alternative. We wanted to assess the diagnostic accuracy and prognostic capability of the GOLD and LLN definition when compared to an expert-based diagnosis.
methodsIn a prospective cohort study, 405 patients aged ≥ 65 years with a general practitioner's diagnosis of COPD were recruited and followed up for 4.5 (median; quartiles 3.9; 5.1) years. Prevalence rates of COPD according to GOLD and three LLN definitions and diagnostic performance measurements were calculated. The reference standard was the diagnosis of COPD of an expert panel that used all available diagnostic information, including spirometry and bodyplethysmography.
resultsCompared to the expert panel diagnosis, 'GOLD-COPD' misclassified 69 (28%) patients, and the three LLNs misclassified 114 (46%), 96 (39%), and 98 (40%) patients, respectively. The GOLD classification led to more false positives, the LLNs to more false negative diagnoses. The main predictors beyond the FEV1/FVC ratio for an expert diagnosis of COPD were the FEV1 % predicted, and the residual volume/total lung capacity ratio (RV/TLC). Adding FEV1 and RV/TLC to GOLD or LLN improved the diagnostic accuracy, resulting in a significant reduction of up to 50% of the number of misdiagnoses. The expert diagnosis of COPD better predicts exacerbations, hospitalizations and mortality than GOLD or LLN.
conclusionsGOLD criteria over-diagnose COPD, while LLN definitions under-diagnose COPD in elderly patients as compared to an expert panel diagnosis. Incorporating FEV1 and RV/TLC into the GOLD-COPD or LLN-based definition brings both definitions closer to expert panel diagnosis of COPD, and to daily clinical practice.
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