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Peer-reviewedCC BY-NCAnnals of medicine

Race-neutral GLI-2022 interpretation in GOLD-positive COPD: reclassification in a Jordanian clinical cohort.

  • Walid Al-Qerem1
  • Anan Jarab2
  • Khaled Al Oweidat3
  • Judith Eberhardt4
  • Osama AlKouri5
  • Dina K Al-Hashaki1
  • Lama Sawaftah1
5 affiliations
  1. 1Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan.
  2. 2Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
  3. 3Pulmonary and Sleep Department, The University of Jordan, Amman, Jordan.
  4. 4Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK.
  5. 5Faculty of Nursing, Yarmouk University, Irbid, Jordan.
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Abstract

Background

Diagnostic 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

This 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

Of 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

Over 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.

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Cite

BibTeXRIS
BibTeX
@article{alqerem2026raceneutral,
  title = {{Race-neutral GLI-2022 interpretation in GOLD-positive COPD: reclassification in a Jordanian clinical cohort.}},
  author = {Walid Al-Qerem and Anan Jarab and Khaled Al Oweidat and Judith Eberhardt and Osama AlKouri and Dina K Al-Hashaki and Lama Sawaftah},
  journal = {Annals of medicine},
  year = {2026},
  month = oct,
  doi = {10.1080/07853890.2026.2749180},
  url = {https://europepmc.org/article/MED/42899456},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Race-neutral GLI-2022 interpretation in GOLD-positive COPD: reclassification in a Jordanian clinical cohort.
AU  - Walid Al-Qerem
AU  - Anan Jarab
AU  - Khaled Al Oweidat
AU  - Judith Eberhardt
AU  - Osama AlKouri
AU  - Dina K Al-Hashaki
AU  - Lama Sawaftah
PY  - 2026
DA  - 2026/10/20
JO  - Annals of medicine
DO  - 10.1080/07853890.2026.2749180
UR  - https://europepmc.org/article/MED/42899456
AB  - Background  Diagnostic 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  This 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  Of 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  Over 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.
SN  - 0785-3890
SN  - 1365-2060
ER  -