Diagnosing chronic obstructive pulmonary diseaseBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6171 (Published 24 November 2015) Cite this as: BMJ 2015;351:h6171
- Francesca Conway, academic foundation year 2 doctor1,
- Azeem Majeed, general practitioner and professor of primary care1,
- Graham Easton, general practitioner and lead for education research1
- 1Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
- Correspondence to: F Conway
- Accepted 15 September 2015
What you need to know
Have a low threshold for considering chronic obstructive pulmonary disease (COPD) in any patient over 35 years old with dyspnoea, chronic cough, chronic sputum, wheeze or frequent chest infections, in the presence of a COPD risk factor such as smoking
Make the diagnosis of COPD on the basis of symptoms and post-bronchodilator spirometry (FEV1/FVC ratio <0.70)
A 55 year old man attends surgery with a productive cough for nine months, which he has put down to his smoking. He had “chest infections” the previous winter and takes ramipril for hypertension. His breathing is now preventing him from climbing stairs.
What you should cover
Have a low threshold for considering chronic obstructive pulmonary disease (COPD)—COPD is often identified only in the advanced stage. Prompt diagnosis allows early intervention. Suspect COPD in patients over 35 years old with dyspnoea, chronic cough or sputum, or wheeze or frequent chest infections (winter “bronchitis”) in the presence of a risk factor (see box 1).1
Establish the onset, pattern of symptoms, and severity—These may help predict the course of disease. Has the patient attended hospital with chest problems before? When was the patient’s breathing last “good”? Is there anything that breathing problems stop the patient from doing, such as getting dressed or climbing stairs?
Elicit risk factors—See box 1.
Exclude other diagnoses and elicit comorbidities— …
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