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Forced spirometry demonstrating airflow obstruction after bronchodilation is required to confirm the diagnosis using a threshold of forced expiratory volume in 1\u2005s (FEV\n                    <jats:sub>1<\/jats:sub>\n                    )\/forced vital capacity (FVC) ratio &lt;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 \u201cvolume\u201d or \u201cflow\u201d responders. Volume responders have reduced FVC due to gas trapping causing FEV\n                    <jats:sub>1<\/jats:sub>\n                    \/FVC \u22650.7 pre-BD, but a volume response occurs post-BD with a greater improvement in FVC relative to FEV\n                    <jats:sub>1<\/jats:sub>\n                    decreasing the ratio to &lt;0.7. Flow responders show a greater FEV\n                    <jats:sub>1<\/jats:sub>\n                    improvement relative to FVC which may increase FEV\n                    <jats:sub>1<\/jats:sub>\n                    \/FVC from &lt;0.7 pre-BD to \u22650.7 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.\n                  <\/jats:p>","DOI":"10.1183\/13993003.01603-2024","type":"journal-article","created":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T11:15:45Z","timestamp":1733397345000},"page":"2401603","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":67,"title":["GOLD Science Committee recommendations for the use of pre- and post-bronchodilator spirometry for the diagnosis of 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