COPD QRG Identification and Diagnosis

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Introduction

Prevention & awareness

Identification & diagnosis

Chronic care

Acute care

Self care

End-of-Life care

Asthma

Implementing the strategy

Identification and Diagnosis Further Resources

COPD National Strategy Slide Kit (members only)

Consultation on a strategy for COPD (Feb 2010)

PCRS-UK COPD National Strategy Resources

PCRJ COPD National Strategy Supplement

PCRS-UK Guidance on the Diagnosis and Management of COPD

GOLD COPD Guidance

NICE COPD Guidance

Conditions of Use

Back to COPD Quick Reference Guide

COPD National Strategy Quick Reference Guide
Identification and diagnosis

Recommendation 7: In line with WHO advice, all people with a diagnosis of COPD and/ or history of adult asthma should be assessed for alpha – 1- antitrypsin deficiency.

Recommendation 8: A diagnosis of COPD should be confirmed by quality assured spirometry and other investigations appropriate to the individual.

Recommendation 9: An assessment of the severity and presence of co-morbid conditions should be made at the point of initial diagnosis, and at least every three years.

Recommendation 10: Disease registers should be accurate and used to improve COPD outcomes..

The approach to identification and diagnosis has to be multifaceted

People need to be aware of the symptoms of lung disease and when to seek advice
Health care professionals must be competent in the assessment and diagnosis of COPD

Identifying new cases of COPD in primary care

The first priority are smokers aged 40 or above with a 20 year pack history, frequent courses of antibiotics, symptoms of chronic cough and/or breathlessness. Other important groups are ex-smokers, those with previous pulmonary tuberculosis, a first-degree relative with COPD and occupational exposure
The diagnosis requires high quality post bronchodilator spirometry combined with clinical assessment and exclusion of other diagnoses (see Figure 2. COPD Diagnosis flow chart)

Spirometry
Standards of spirometry performance and interpretation in primary care have recently been published.

The spirometer must be able to record FEV1, FVC, FEV1/FVC ratio, and display a graph of volume against time
The spirometrist must be trained in the use of the spirometer (including calibration) and in assessing technical adequacy of readings
The patient should be appropriately prepared, including advice on stopping bronchodilators well in advance of reversibility testing.

Assessment of severity
No single measure can give an adequate assessment of the severity of COPD.

Lung function: The NICE COPD guideline classification of mild moderate and severe based on FEV1 may be adapted to include GOLD stage 1 for symptomatic patients with a reduced ratio but normal FEV1.(see table 1. Differences in COPD severity classification)
A more holistic assessment in primary care: should include FEV1, MRC dyspnoea score, oximetry, BMI presence of cor pulmonale and/or co-morbidities. Alpha-1 antitrypsin deficiency is associated with early onset of disease
Multidimensional indices: The BODE index is recommended by NICE but requires a 6 minute walking test which can be difficult to undertake in primary care. An alternative is the DOSE index

Further resources

Author: Dr Hilary Pinnock, University of Edinburgh, and Whitstable Medical Practice, Kent | Editor: Dr Mark Levy, Kingsbury, London

This COPD National Strategy Quick Reference Guide is provided to you by the Primary Care Respiratory Society UK (PCRS-UK)
and is an interpretation of the document Consultation on a Strategy for Chronic Obstructive Pulmonary Disease (COPD) in England (February 2010) written by the Department of Health.
This Quick Reference Guide has been supported by an educational grant from Allen & Hanburys,
the specialist respiratory division of GlaxoSmithKline, AstraZeneca UK Ltd and Boehringer Ingelheim Ltd/Pfizer Ltd.
The views expressed in the materials are not necessarily those of either the Department of Health, the sponsors or the Primary Care Respiratory Society UK (PCRS-UK). © PCRS-UK

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