Key Indicators for Considering a Diagnosis of COPD

  • Consider COPD, and perform spirometry, if any of these indicators are present in an individual over age 40.
    • Presence of multiple key indicators increases the probability of a true diagnosis of COPD.
    • Spirometry is needed to establish a diagnosis of COPD.

Key Indicators
  • Progressive (worsens over time)
  • Usually worse with exercise
  • Persistent (present every day)
  • Described by the patient as an “increased effort to breathe,” “heaviness,” “air hunger,” or “gasping.”
Chronic cough
  • May be intermittent and may be unproductive
Chronic sputum production
  • Any pattern of chronic sputum production may indicate COPD
History of exposure to risk factors
  • Tobacco smoke
  • Occupational dusts and chemicals
  • Smoke from home cooking and heating fuels

Differential Diagnosis

Suggestive features (but not always present)
  • Onset in mid-life (onset in younger adults, consider A1AT deficiency)
  • Symptoms slowly progressive.
  • Long history of tobacco smoking.
  • Dyspnea during exercise.
  • Largely irreversible airflow limitation.
  • Onset early in life (often childhood).
  • Symptoms vary from day to day.
  • Symptoms at night/early morning.
  • Allergy, rhinitis, and/or eczema also present.
  • Family history of asthma.
  • Largely reversible airflow limitation.
  • Fine basilar crackles on auscultation.
  • Chest X-ray shows dilated heart, pulmonary edema.
  • Pulmonary function tests indicate volume restriction, not airflow limitation.
  • Large volumes of purulent sputum.
  • Commonly associated with bacterial infection.
  • Coarse crackles/clubbing on auscultation.
  • Chest X-ray/CT shows bronchial dilation, bronchial wall thickening.
  • Onset all ages
  • Chest X-ray shows lung infiltrate.
  • Microbiological confirmation.
  • High local prevalence of tuberculosis.
Obliterative bronchiolitis
  • Onset in younger age, nonsmokers.
  • May have history of rheumatoid arthritis or fume exposure.
  • CT on expiration shows hypodense areas.
Diffuse panbronchiolitis
  • Most patients are male and nonsmokers.
  • Almost all have chronic sinusitis.
    Chest X-ray and HRCT show diffuse small centrilobular nodular opacities and hyperinflation.

GOLD Classification and Therapy


Vaccination of Adults with COPD