Current COPD management programs and guidelines overdiagnose elderly patients and underdiagnose young ones, according to an analysis published online July 1 in the BMJ. The article details the problem and calls for the adoption of lower limits of normal (LLN) criteria for airflow obstruction that are specific for different populations.

The Global Initiative for Obstructive Lung Disease (GOLD) guidelines are based on consensus expert opinion, they do not effectively diagnose COPD, say Martin R. Miller, MD, from the University of Birmingham in the United Kingdom, and Mark L. Levy, MBChB, from the Harrow Clinical Commissioning Group in London, United Kingdom.

In their analysis, Dr Miller and Dr Levy propose that the GOLD criteria be refined by the addition of LLN criteria. At a minimum, they suggest, the LLN should be incorporated into future studies of COPD.