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COPD Assessment

COPD is generally an insidious and slowly progressive disease. In our sedentary society, patients may lose 50% of their lung function before symptoms develop. Many patients report no complaints except for a tendency to have prolonged cough after an upper respiratory infection until a particular bad chest cold after which they have had progressive dyspnea. Recent national data indicate that 5.4% of adults have clinically significant airway obstruction from bronchitis and 0.8% from emphysema; overall about 16 million persons in the USA have COPD. Because the disease is seriously under diagnosed, as many as 30 million persons may be affected. To assess for COPD, a patient's history, review of systems, laboratory data, and physical findings will be considered in the evaluation of COPD.

Readings Table

Goldman & Bennett, pp. 393-401

Jump Table

Review of Systems
Physical Exam
Laboratory Tests




In COPD, particular attention should be directed to:



History components that include:
exposure to risk factors such as tobacco, occupational exposures PMH of asthma, allergy, sinusitis, nasal polyps
family history of COPD or other chronic respiratory disorder pattern of symptom development, especially slow or rapid development and early or late onset
history of exacerbations comorbidities
current medical treatments impact of illness on life, work, family support systems
possibility for reducing risk factors - especially smoking


ROS components that include:
chronic cough - starts intermittent, then daily sputum production
dyspnea - progressive, DOE activity limitations


The physical exam is usually not as diagnostic as signs of airflow limitation (abnormal spirometry). Critical for excluding other diagnoses.




Laboratory Tests
  • Polycythemia - increased Hct and Hgb driven by chronic hypoxemia
  • Leukocytosis - infection/necrosis/injury/inflammation
ABG's Always measure in patients with FEV1 < 40% predicted, with signs of respiratory failure or right heart failure. CO2 retention associated with increasing severity of disease.
CXR over inflated, reduced vascular markings, low or flat diaphragm, increased retrosternal space on lateral.

(See: Connolly, Maria A. "Black, White, Shades of Gray: Common Abnormalities in Chest Radiographs", AACN Clinical Issues, Vol. 12, No. 2, p. 259-269, May 2001).

Alpha-1 antitrypsin deficiency screening patients with COPD at young age (< 45years), or family history of the disease.
Alpha-1 antitrypsin deficiency screening patients with COPD at young age (< 45years), or family history of the disease.
Spirometry Spirometry is the most sensitive and specific test for the diagnosis of COPD and assessment of severity of COPD.

Perform spirometry if any of these indicators are present:

  • Chronic cough

  • Dyspnea that is progressive, worse with exertion, worse with respiratory infections, or described as "heaviness", "air hunger", "gasping", or "increased effort to breathe".

  • History of exposure to risk factors


There are many disorders that may cause signs and symptoms similar to those seen in COPD. It is important to consider all possible diagnoses when evaluating patients, and to narrow your focus though further examination and testing. Listed in this table are some possibilities to consider when seeing a patient with dyspnea, airflow limitation, cough, and/or increased work of breathing.

Differential Diagnosis: consider the following in the differential.
COPD usually onset is mid life; slow progression of symptoms; long smoking history; dyspnea during exercise; often diminished breath sounds on auscultation; airflow limitation is mostly irreversible.
Asthma usually early life onset (but can be late); symptoms vary day to day; often worse at night or early AM; allergy, rhinitis, and/or eczema may be present; family history of asthma; airflow limitation mostly reversible.
CHF fine basilar crackles on auscultation; CXR - dilated heart and pulmonary edema; PFTÕs - volume restriction - not airflow limitation.
Bronchiectasis large volumes of purulent sputum; often associated with a bacterial infection; coarse crackles on auscultation; CXR and chest CT - bronchial dilation and bronchial wall thickening.
Tuberculosis onset - all ages; CXR - infiltrate or nodular lesions, upper lobe cavitary lesions; microbiological confirmation; high local prevalence or known exposure to tuberculosis.
Obliterative Brochiolitis onset - younger age; nonsmokers; possible history of rheumatoid arthritis or fume exposure; chest CT - hypodense areas on expiration.
Diffuse Panbronchiolitis most are male; nonsmokers; chronic sinusitis; CXR and chest CT - small, centrilobular, nodular opacities and hyperinflation.


Classification of COPD by severity

(Global Strategy for the Diagnosis, Management, and Prevention of COPD, workshop report of the expert panel, 2001)

Stage 0: - At Risk - normal spirometry chronic symptoms (cough, sputum production)

Stage I: - Mild COPD - FEV1/FVC < 70% predicted FEV1 > 80% predicted With or without chronic symptoms

Stage II: - Moderate COPD - FEV1/FVC < 70%

30% < FEV1 < 80% predicted

(IIA: 50% < FEV1 < 80% predicted)

(IIB: 30% < FEV1 < 50% predicted)

With or without chronic symptoms

Stage III: - Severe COPD - FEV1/FVC < 70%

FEV1 < 30% predicted or FEV1 <50% predicted plus

respiratory failure or clinical signs of right heart failure

Further Information

Medline Search on COPD with valuable links and articles on treatment, general knowledge, and other related COPD information.

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