Confirming the Diagnosis

9 min readLesson 1 of 15

Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable disease characterised by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases — most commonly tobacco smoke, but also biomass fuel exposure, occupational dusts/fumes, and genetic factors such as alpha-1-antitrypsin deficiency.

Diagnostic requirements (GOLD)

Compatible symptoms: dyspnoea, chronic cough and/or sputum production, and/or a history of recurrent lower respiratory tract infections.
A history of exposure to risk factors (tobacco, biomass fuel, occupational, genetic).
Spirometry is mandatory to confirm the diagnosis — symptoms and exposure history alone are insufficient.
Post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow limitation and establishes the diagnosis in the appropriate clinical context.

The fixed ratio has limitations

Using a fixed FEV1/FVC <0.70 threshold can overdiagnose COPD in older adults (in whom the ratio declines with normal ageing) and underdiagnose it in younger adults. Always interpret spirometry in the context of the clinical history and consider using lower limit of normal (LLN) values where borderline results occur in these age groups.

Knowledge Check

A 78-year-old lifelong non-smoker with no respiratory symptoms has a post-bronchodilator FEV1/FVC of 0.68 on routine spirometry. What is the most appropriate interpretation?

COPD: Diagnosis & ManagementConfirming the Diagnosis

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Diagnosis & Assessment

Confirming the Diagnosis

9 min readLesson 1 of 15

Diagnostic requirements (GOLD)

Compatible symptoms: dyspnoea, chronic cough and/or sputum production, and/or a history of recurrent lower respiratory tract infections.
A history of exposure to risk factors (tobacco, biomass fuel, occupational, genetic).
Spirometry is mandatory to confirm the diagnosis — symptoms and exposure history alone are insufficient.
Post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow limitation and establishes the diagnosis in the appropriate clinical context.

The fixed ratio has limitations

Knowledge Check

A 78-year-old lifelong non-smoker with no respiratory symptoms has a post-bronchodilator FEV1/FVC of 0.68 on routine spirometry. What is the most appropriate interpretation?