[Interpretation of joint statement from GOLD/GLI regarding the use of spirometry to define airflow obstruction and diagnose COPD].

Abstract

Chronic obstructive pulmonary disease(COPD) remains a leading cause of mortality worldwide, and spirometry is the essential objective test for identifying airflow obstruction and confirming COPD in the appropriate clinical context. In 2026, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Global Lung Function Initiative(GLI) published a joint statement on the use of spirometry to define airflow obstruction and diagnose COPD. This statement reframes the long-standing debate between the fixed FEV₁/FVC ratio and the lower limit of normal(LLN), emphasizing that these criteria should not be viewed simply as competing definitions, but as tools serving different clinical and epidemiological purposes.GOLD continues to recommend a fixed post-bronchodilator FEV₁/FVC ratio of <0.70 to confirm persistent airflow obstruction in symptomatic individuals with relevant exposures, whereas GLI supports using the LLN to identify physiological airflow obstruction across populations, particularly to mitigate age-related misclassification. The joint statement further highlights that major global challenges extend beyond threshold selection to include the underuse of spirometry, variable test quality, and the interpretation of spirometric results without sufficient clinical context. Furthermore, spirometry alone is insufficient for diagnosing COPD; however, normal spirometric findings from technically acceptable tests can help exclude COPD. Results near diagnostic thresholds warrant repeat testing or further clinical evaluation.The statement also supports transitioning to the 2022 GLI race-neutral reference equations while cautioning that predicted values and severity classifications require careful interpretation across diverse populations. Regarding severity grading, both GOLD percent-predicted thresholds and ATS/ERS z-score classifications possess inherent limitations. Consequently, physiological impairment should be evaluated alongside symptoms, exacerbation risk, comorbidities, imaging findings, and clinically meaningful outcomes.This review summarizes the main viewpoints of the GOLD-GLI joint statement, focusing on the practical differences between the fixed ratio and LLN, barriers to spirometry implementation, quality assurance, reference equations, and severity grading. In addition, we integrate recent Chinese community-based and real-world evidence, including simplified pre-bronchodilator spirometry for population screening, portable spirometry in primary care, and artificial intelligence-assisted spirometry interpretation. By combining updated international consensus with local evidence and emerging technologies, this article provides a practical reference for standardizing COPD diagnosis and optimizing screening strategies in China. 慢性阻塞性肺疾病（简称慢阻肺病）是全球主要致死性疾病之一，肺量计检查仍是识别气流阻塞和确认慢阻肺病诊断的核心客观工具。2026年，慢性阻塞性肺疾病全球倡议（GOLD）与全球肺功能倡议（GLI）就肺量计界定气流阻塞及慢阻肺病诊断发布联合声明。GOLD主张采用吸入支气管舒张剂后FEV₁/FVC<0.70的固定比值，GLI则强调依据年龄、身高、性别等因素计算的正常值下限（LLN）。该声明未简单判定二者优劣，而是指出二者分别服务于不同的临床与流行病学目标，并强调当前更紧迫的问题在于肺量计应用不足、检查质量不稳定及结果脱离临床背景的机械性解读。本文系统梳理声明主要观点，重点介绍双方在肺量计临床应用障碍、固定比值与LLN差异、检查质量、预计值方程及严重程度分级等方面达成的共识，并结合我国临床实践、最新研究及技术进展提出建议，以期为我国慢阻肺病规范化诊断和筛查策略优化提供参考。.