Chronic Obstructive Pulmonary Disease (COPD)

🔍 When to Suspect

Individuals over 35 with a significant smoking history who present with exertional breathlessness, chronic cough, or frequent 'winter bronchitis'

From the full topic in The Ocean Library: Chronic Obstructive Pulmonary Disease (COPD)

🧭 When to suspect

Chronic obstructive pulmonary disease (COPD) is a common, progressive disorder of persistent airflow obstruction caused by an abnormal inflammatory response of the airways and lung – in the UK almost always to tobacco smoke.

The diagnosis is clinical, suspected on symptoms and risk factors, and confirmed by spirometry: a post-bronchodilator FEV1/FVC ratio below 0.7 indicates persistent obstruction that does not fully reverse.

Suspect COPD in anyone over 35 with a risk factor (generally current or past smoking) who reports one or more of:

• Exertional breathlessness

• A chronic cough

• Regular sputum production

• Frequent winter ‘bronchitis’

• Wheeze

A steady decline in exercise tolerance is the most telling pattern.

Once you suspect it:

• Confirm obstruction with spirometry

• Decide the inhaled pathway by asthmatic features

• Prevent and treat exacerbations

• Address the two things that actually change survival – smoking cessation and long-term oxygen in the hypoxaemic

Post-bronchodilator FEV1 % predicted	Severity of airflow obstruction	Stage
≥ 80% (diagnose COPD only if symptomatic)	Mild	Stage 1
50–79%	Moderate	Stage 2
30–49%	Severe	Stage 3
< 30%	Very severe	Stage 4

The diagnostic gate is the ratio (FEV1/FVC < 0.7); the forced expiratory volume in one second (FEV1) % predicted then grades severity. Mild (stage 1) obstruction is only labelled COPD if the person also has symptoms.

Source: NICE NG115

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