The Global initiative for chronic Obstructive Lung Disease (GOLD) report states that the diagnosis of chronic obstructive pulmonary disease (COPD) should be considered in individuals with chronic respiratory symptoms and / or exposure to risk factors. Forced spirometry demonstrating airflow obstruction after bronchodilation is required to confirm the diagnosis using a threshold of forced expiratory volume in 1 s (FEV1) / forced vital capacity (FVC) ratio<0.7. This GOLD Science Committee review weighs the evidence for using pre- or post-bronchodilator (BD) spirometry to diagnose COPD.Cohort studies have shown that pre- and post-BD spirometry give concordant diagnostic results in most cases, although the prevalence of COPD is up to 36% lower with post-BD values. Discordant results may occur in "volume" or "flow" responders. Volume responders have reduced FVC due to gas trapping causing FEV1/ FVC ratio >0.7 pre-BD, but a volume response occurs post-BD with a greater improvement in FVC relative to FEV1 decreasing the ratio to <0.7. Flow responders show a greater FEV1 improvement relative to FVC which may increase FEV1/ FVC from <0.7 pre-BD to >0.7 post-BD; these individuals have an increased likelihood of developing post-BD obstruction during follow up and require monitoring longitudinally.GOLD 2025 recommends using pre-BD spirometry to rule out COPD and post-BD measurements to confirm the diagnosis. This will reduce clinical workload. Post-BD results close to the threshold should be repeated to ensure a correct diagnosis is made. Post-BD measurements ensure that volume responders are not overlooked and limit COPD overdiagnosis.

中文翻译：

---

GOLD 科学委员会关于使用支气管扩张剂前和后肺活量测定法诊断 COPD 的建议。


慢性阻塞性肺病全球倡议 （GOLD） 报告指出，对于有慢性呼吸道症状和/或暴露于危险因素的个体，应考虑慢性阻塞性肺病 （COPD） 的诊断。需要用力肺活量测定显示支气管扩张后气流阻塞，以使用 1 s 用力呼气容积 （FEV1） 阈值 （FEV1） / 用力肺活量 （FVC） 比值 <0.7 来确认诊断。GOLD 科学委员会的这项审查权衡了使用支气管扩张剂前或后 （BD） 肺活量测定法诊断 COPD 的证据。队列研究表明，在大多数情况下，BD 前和后肺活量测定可给出一致的诊断结果，尽管 BD 后值的 COPD 患病率降低高达 36%。不一致的结果可能会出现在 “volume” 或 “flow” 响应者中。由于气体捕获导致 BD 前 FEV1/FVC 比率 >0.7，因此体积反应者降低了 FVC，但 BD 后发生体积反应，相对于 FEV1 FVC 改善更大，该比率降低至 <0.7。相对于 FVC，血流应答者显示出更大的 FEV1 改善，这可能会将 FEV1/FVC 从 BD 前的 <0.7 增加到 BD 后的 >0.7;这些个体在随访期间发生 BD 后梗阻的可能性增加，需要纵向监测。GOLD 2025 建议使用 BD 前肺活量测定法排除 COPD 和 BD 后测量以确认诊断。这将减少临床工作量。应重复接近阈值的 BD 后结果，以确保做出正确的诊断。BD 后测量可确保容量反应者不被忽视，并限制 COPD 过度诊断。