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Vol. 60. Issue 1.
Pages 10-15 (January 2024)
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Vol. 60. Issue 1.
Pages 10-15 (January 2024)
Original Article
Impact of Applying the Global Lung Initiative Criteria for Airway Obstruction in GOLD Defined COPD Cohorts: The BODE and CHAIN Experience
Juan P. de-Torresa,b,
Corresponding author

Corresponding author.
, Ciro Casanovac, José M. Marínd, Carlos Cabrerae, Marta Marína,f, Ana Ezpondag, Borja G. Cosioh,i, Cristina Martínezj, Ingrid Solanesk, Antonia Fusterl, Myriam Callem, Germán Peces-Barban, Carolina Goteran, Nuria Feu-Colladoo, Alicia Marinp, Ana Belén Alcaidea, Matilde Sangroa, Gorka Bastarrikag, Bartolome R. Celliq
a Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
b Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
c Pulmonary Department-Research Unit, Hospital Universitario Nuestra Señora de Candelaria, CIBERES, ISCIII, Universidad de La Laguna, Tenerife, Spain
d Pulmonary Department, Hospital Universitario Miguel Servet, IIS Aragon & CIBERES, University of Zaragoza, Zaragoza, Spain
e Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
f Hospital Universitario Lozano Blesa, Zaragoza, Spain
g Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
h Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Mallorca, Spain
i Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
j Instituto de Investigación Sanitaria del Principado de Asturias (ISPA-FINBA), Spain
k Pulmonary Department, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
l Pulmonary Department, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
m Department of Respiratory Medicine, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
n Department of Respiratory Medicine, Hospital Universitario Fundación Jiménez Díaz, CIBERES, Madrid, Spain
o Pulmonary Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
p Pulmonary Department, Hospital Universitario German Trias y Pujol, Barcelona, Spain
q Pulmonary Department, Brigham and Women's Hospital, Boston, MA, United States
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Tables (2)
Table 1. Clinical and physiological characteristics of patients from each cohort.
Table 2. Clinical and physiological characteristics of patients without airflow limitation based on the GLI criteria.
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The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this study was to explore the impact of the application of the AL GLI criteria in two well characterized GOLD-defined COPD cohorts.


COPD patients from the BODE (n=360) and the COPD History Assessment In SpaiN (CHAIN) cohorts (n=722) were enrolled and followed. Age, gender, pack-years history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, history of exacerbations and survival were recorded. CT-detected comorbidities were registered in the BODE cohort. The proportion of subjects without AL by GLI criteria was determined in each cohort. The clinical, CT-detected comorbidity, and overall survival of these patients were evaluated.


In total, 18% of the BODE and 15% of the CHAIN cohort did not meet GLI AL criteria. In the BODE and CHAIN cohorts respectively, these patients had a high clinical burden (BODE3: 9% and 20%; mMRC2: 16% and 45%; exacerbations in the previous year: 31% and 9%; 6MWD<350m: 15% and 19%, respectively), and a similar prevalence of CT-diagnosed comorbidities compared with those with GLI AL. They also had a higher rate of long-term mortality – 33% and 22% respectively.


An important proportion of patients from 2 GOLD-defined COPD cohorts did not meet GLI AL criteria at enrolment, although they had a significant burden of disease. Caution must be taken when applying the GLI AL criteria in clinical practice.

Global Lung Function Initiative
Airway obstruction


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