{
  "abstract": "Background\n\nDiagnostic interpretation of chronic obstructive pulmonary disease (COPD) depends on the reference equation used to define airflow obstruction. This study examined how often race-neutral Global Lung Initiative (GLI-2022) lower-limit-of-normal (LLN) interpretation reclassified clinically confirmed COPD patients meeting Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as non-obstructed. GLI-2012 Caucasian, GLI-2012 Other/Mixed, and local Jordanian equations were secondary comparators.Methods\n\nThis cross-sectional study included 845 patients aged ≥40 years with newly diagnosed, clinically confirmed COPD attending Jordan University Hospital, Amman, between August 2025 and March 2026. Diagnosis incorporated compatible symptoms, clinical history, post-bronchodilator FEV₁/FVC <0.70, and additional investigations when clinically indicated. Patients with asthma or suspected asthma-COPD overlap were excluded. Predicted values, LLNs, and z scores were computed for each reference equation. Reclassification was examined across FEV₁/FVC bands and using an adjusted bias-reduced logistic model.Results\n\nOf 845 clinically confirmed COPD patients, 224 (26.5%) did not meet the GLI-2022 LLN criterion for airflow obstruction, compared with 262 (31.0%) using GLI-2012 Caucasian, 174 (20.6%) using GLI-2012 Other/Mixed, and 13 (1.5%) using the Jordanian equation. GLI-2022 classified 621 patients as obstructed (73.5%; 95% CI 70.4-76.4), and all three paired comparisons with GLI-2022 were statistically significant (exact McNemar p < 0.001). GLI-2022 reclassification increased from 2.8% at ages 40-49 years to 46.0% at ≥80 years and was concentrated in the post-bronchodilator FEV₁/FVC 0.65-0.699 band.Conclusion\n\nOver a quarter of patients with clinically confirmed COPD in this cohort did not meet the GLI-2022 LLN criterion for airflow obstruction. GLI-2022 LLN-negative status should not be used in isolation to negate a COPD diagnosis established through guideline-based clinical assessment.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan.",
    "Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.",
    "Pulmonary and Sleep Department, The University of Jordan, Amman, Jordan.",
    "Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK.",
    "Faculty of Nursing, Yarmouk University, Irbid, Jordan."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Walid Al-Qerem"
    },
    {
      "affs": [
        1
      ],
      "name": "Anan Jarab"
    },
    {
      "affs": [
        2
      ],
      "name": "Khaled Al Oweidat"
    },
    {
      "affs": [
        3
      ],
      "name": "Judith Eberhardt",
      "orcid": "0000-0003-0745-178X"
    },
    {
      "affs": [
        4
      ],
      "name": "Osama AlKouri",
      "orcid": "0000-0002-3268-2259"
    },
    {
      "affs": [
        0
      ],
      "name": "Dina K Al-Hashaki"
    },
    {
      "affs": [
        0
      ],
      "name": "Lama Sawaftah"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/debt85n9nbpdh.bib",
  "cited_by": 0,
  "doi": "10.1080/07853890.2026.2749180",
  "fulltext_url": "https://europepmc.org/articles/PMC13686211",
  "id": "debt85n9nbpdh",
  "issns": [
    "0785-3890",
    "1365-2060"
  ],
  "landing_url": "https://europepmc.org/article/MED/42899456",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Chronic Obstructive Pulmonary Disease (COPD) Research"
    ]
  ],
  "openalex": "W7223067972",
  "pdf_url": "https://europepmc.org/articles/PMC13686211?pdf=render",
  "pmcid": "PMC13686211",
  "pmid": "42899456",
  "published": "2026-10-20",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/debt85n9nbpdh.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:32Z",
      "native_id": "MED:42899456",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42899456"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Chronic Obstructive Pulmonary Disease (COPD) Research",
      "subfield": "general"
    }
  ],
  "title": "Race-neutral GLI-2022 interpretation in GOLD-positive COPD: reclassification in a Jordanian clinical cohort.",
  "title_text": "Race-neutral GLI-2022 interpretation in GOLD-positive COPD: reclassification in a Jordanian clinical cohort.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:32Z",
  "url": "https://research.draconitic.com/paper/debt85n9nbpdh",
  "venue": "Annals of medicine",
  "versions": []
}