Mount Carmel Health Partners Clinical Guidelines Chronic Obstructive Pulmonary Disease | Page 3
Diagnosis of COPD
The diagnosis of COPD should be confirmed by spirometry. When performing spirometry, measure:
• Forced vital capacity (FVC)
• Forced expiratory volume in one second (FEV1)
• Calculate the FEV1/FVC ratio: postbronchodilator FEV1 is recommended for the diagnosis and assessment of the severity of COPD. FEV1/FVC
ratio should be confirmed by repeat spirometry on a separate occasion if ratio is between 0.6 and 0.8. A FEV1/FVC ratio less than 0.7 con
firm the presence of airflow limitation that is not fully reversible
Other diagnostic tests that may be performed prior to establishing the diagnosis of COPD:
• Bronchodilator reversibility to exclude asthma and establish a lung function baseline
• Chest x-ray to rule out other causes for lung diseases
• Arterial blood gas or pulse oximetry
• Alpha-1 antitrypsin (AAT) deficiency screening; this deficiency is caused by an inherited deficiency of the hepatically-produced protein
alpha-1 antitrypsin, a known lung protector. This test should be performed on patients with COPD of Caucasian descent under the age of 45
or in patients who have a strong family history of COPD
• CBC to assess for anemia
• BNP or NT-proBNP to assess and/or evaluate for heart failure
Goals of COPD Management
1.
2.
3.
4.
5.
6.
7.
8.
Improve health status
Relieve symptoms
Prevent disease progression
Prevent and treat exacerbations
Prevent and treat complications
Improve exercise tolerance
Prevent or minimize side effects from treatment
Reduce mortality
Differential Diagnosis of COPD
Diagnosis
COPD
Asthma
Heart Failure
Bronchiectasis
Tuberculosis
Obliterative
bronchiolitis
Diffuse
Panbronchiolitis
Suggestive Features
Onset mid-life (onset early adulthood–suspicion for alpha-1 antitrypsin deficiency)
Symptoms progress slowly
Long smoking history, although can occur in nonsmokers.
Largely irreversible airflow limitation
Dyspnea during exercise
Onset early in life, often childhood
Symptoms vary from day to day
Symptoms at night/early morning
Allergy, rhinitis and/or eczema
Family history of asthma
Largely reversible airflow limitation
Obesity coexistence
Fine basilar crackles on auscultation
Chest radiograph shows dilated heart, pulmonary edema
Pulmonary function tests typically indicate volume restriction, not airflow limitation
Large volumes of purulent sputum
Commonly associated with recurrent or persistent bacterial infection
Coarse crackles on auscultation, clubbing of digits
Chest radiograph/High-resolution computed tomography (HRCT) shows bronchial dilation, bronchial wall thickening
Onset all ages
Chest x-ray shows lung infiltrate
Microbiological confirmation
High local prevelence of tuberculosis
Onset younger age, nonsmokers
May have history or rheumatoid arthritis or acute fume exposure
Seen after lung or bone marrow transplant
CT on expiration shows hypodense areas
Predominantly seen in patients of Asian descent
Most patients are male and nonsmokers
Almost all have chronic sinusitis
Chest x-ray and HRCT show diffuse small centrilobular nodular opacities and hyperinflation
COPD - 3