Proposed diagnostic criteria for pre-COPD

Potential manifestations of pre-COPD
Symptoms	Chronic bronchitis Dyspnea Intermittent wheeze and sputum production
Pulmonary function	DLCO <80% predicted FEV₁ decline >40 mL/year Preserved ratio impaired spirometry (PRISM)
Imaging	Emphysema on CT (>5% or visual dx) Vascular remodeling or pruning Airway thickening

A diagnosis of pre-COPD should be considered in patients with risk factors for COPD who have any of the above characteristics without airflow limitation (FEV₁/FVC >0.7).

COPD: chronic obstructive pulmonary disease; DLCO: diffusing capacity of carbon monoxide; FEV₁: forced expiratory volume in one second; CT: computed tomography; FVC: forced vital capacity.

Adapted from:

Celli B, Fabbri L, Criner G, et al. Definition and nomenclature of chronic obstructive pulmonary disease: Time for its revision. Am J Respir Crit Care Med 2022; 206:1317.
Han MK, Agusti A, Celli BR, et al. From GOLD 0 to Pre-COPD. Am J Respir Crit Care Med 2021; 203:414.

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Proposed diagnostic criteria for pre-COPD