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Patient Oriented Evidence that Matters

Introduction COPD POEM PDF
The COPDX Plan
Confirm diagnosis & assess severity
Optimise function
Prevent deterioration
Develop support network & self-management plan
eXacerbations manage appropriately
Review of drug use in COPD
Appendix One - Resources and contacts

C Confirm diagnosis & assess severity

Earlier diagnosis of COPD

The key components of earlier diagnosis for COPD are:

  • Identifying all smokers enrolled in the practice,
  • Screening some/all smokers for airflow obstruction ideally with spirometry or possibly PEFR,
  • Using spirometry to ensure an accurate diagnosis.

The greatest gain will be in younger patients with early clinical or spirometric features of COPD if they can be persuaded to give up smoking.

The main symptoms of COPD are breathlessness, cough and sputum production. The diagnosis should be considered in patients aged over 35 years with recurrent episodes of these symptoms, especially if they have significant exposure to tobacco smoke, pollution, occupational dusts or fumes or they have a strong family history of COPD.

Examination findings such as wheeze, hyperinflation and prolonged expiratory phase are common in COPD, however their absence does not exclude the diagnosis.

Spirometry is the gold standard for the diagnosis of COPD

The gold standard for the diagnosis, assessment and monitoring of COPD is spirometry. The use of spirometry in the diagnosis of COPD is summarised in the flow chart below.

Diagnosis of COPD
From: The Asthma and Respiratory Foundation of New Zealand. Diagnosis & Treatment of COPD.

The role of Peak Expiratory Flow Rate (PEFR) in COPD

Although spirometry is essential in COPD there is still a role for PEFR.

There is poor correlation between PEFR and FEV1 caused by variations in the degree of airway collapsibility between COPD patients. In addition the small changes in airway function typical of COPD are not reliably detected by PEFR.

However, a recent investigation demonstrated that a PEFR of <80% of predicted normal detected approximately 90% of patients aged between 50 and 90 years-old with COPD. The patients that were missed all had mild COPD. Of the people who had PEFR <80% of predicted normal, 17% did not have COPD (Jackson, 2003).

It seems then that PEFR may be a useful case finding tool with the proviso that we will miss some people with COPD (this study suggests they will tend to have mild COPD), and quite a few people with PEFR <80% will turn out not to have COPD. If PEFR is used for screening, those with positive or equivocal results should be referred for formal spirometry and smokers with negative results cannot be reassured that their lung function is normal.

PEFR also plays an important role when people have a mixed picture of COPD and asthma with significant reversibility of airway obstruction.

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