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The aim of this study was to determine the concordance between the ATS/ERS recommendations between 2005 and 2021,and to identify the factors associated with a possible discordance.This was a cross-sectional observational study carried out in 2022 in the EFR department of the Habib Bourguiba University Hospital in Sfax.In total,we recruited 400 patients.The concordance between the two recommendations was good in the classification of obstructive syndrome and very good in the classification of restrictive and mixed syndromes, as well as in the classification of normal subjects.The degree of agreement in the classification of the severity of obstructive syndrome was moderate.Agreement concerning the response to bronchodilators was good.Age <18 years,measured FEV1,measured FEV1/FVC ratio and RV/PTC ratio expressed in z-score were among the factors significantly associated with discordance in the classification of the severity of obstructive syndrome.In patients with a clinical picture of asthma and COPD, measured FEV1 and FEV1 expressed as a z-score were significantly lower in those with a discordance in response to bronchodilators.