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  1. Andrew McIvor, professor of respiratory medicine1,
  2. Paul Little, professor of primary care research2
  1. 1McMaster University, T2127, Firestone Institute for Respiratory Health, St Josephs Healthcare, Hamilton, ON, Canada L8N 4A6
  2. 2Community Clinical Sciences Division, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST
  1. Correspondence to: A McIvor amcivor{at}stjosham.on.ca

    A 58 year old female smoker presents with a complaint of dyspnoea associated with chronic cough and sputum production during the winter months. Her general health is good. She recently took early retirement to spend more time with her grandchildren but found that she is too breathless to lift and carry them or to look after them safely in the park.

    What issues you should cover

    Chronic obstructive pulmonary disease (COPD) is largely caused by smoking and is characterised by progressive, partially reversible airflow obstruction, systemic manifestations (skeletal muscle dysfunction, depression, and secondary polycythaemia), and increasing frequency and severity of exacerbations. The main symptoms—usually insidious in onset and progressive—are shortness of breath and inability to tolerate physical activity.

    History—Take a careful history to determine whether she has COPD, focusing on the main symptoms. Does she smoke or have significant exposure to secondhand smoke or occupational dust? Ask about history of …

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