A diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough, and/or sputum production and an appropriate history of exposure to noxious stimuli. However, not all patients with these symptoms have COPD, and a spirometry demonstrating a post-bronchodilator forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio < 70% (or less than the lower limit of normal, if available) is required to make a definitive diagnosis. Starting maintenance inhalers without first objectively diagnosing COPD results in unnecessary treatment in those patients who do not actually have the disease. In turn, this exposes these patients to both the side-effects and the cost of these medications, and might delay the appropriate diagnosis.

Conditions: Chronic obstructive pulmonary disease (COPD)

Diagnostic Tests: Spirometry

Treatments: Long-term maintenance inhalers

Sources

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD 2017 Global Strategy for the Diagnosis, Management and Prevention of COPD [Internet]. 2017 [cited 2017 May 5]. Available from: http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/.
• Qaseem A, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011 Aug 2;155(3):179-91. (PubMed)
• United States of America Department of Veterans Affairs and the Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Chronic Obstructive Pulmonary Disease [Internet]. 2014 Dec [cited 2017 May 5]. Available from: https://www.healthquality.va.gov/guidelines/CD/copd/VADoDCOPDCPG2014.pdf.