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Feature Article

COPD: practical aspects of case finding, diagnosing and monitoring

Julia AE Walters, Alan J Crockett, Vanessa M McDonald

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An updated version is available in the linked supplement

Abstract

Does my patient have chronic obstructive pulmonary disease (COPD), and does it matter?

Key Points

  • Diagnosis of COPD is often delayed and a high proportion of cases in primary care are unrecognised.
  • COPD is often misdiagnosed in primary care, probably as a result of not using spirometry for diagnosis.
  • Screening systematically or opportunistically with questionnaires can be used to case-find in general practice. Expiratory flow devices are used to determine the need for diagnostic testing.
  • Spirometry is essential to diagnose COPD. COPD is present if the post-bronchodilator FEV1/FVC ratio is below 0.7 and FEV1 is less than 80% predicted.
  • Telling smokers their ‘lung age’ after spirometry increases their chances of successfully quitting.
  • The results of spirometry together with symptoms and exacerbation frequency guides the management of COPD.
  • Complex lung function tests to distinguish between asthma and COPD are not usually required.

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