Last reviewed: November 2017
Last updated: November  2017

Important updates

Updated international guidance on diagnosis, treatment, and prevention of COPD

  • The assessment tool, which is used to classify patients into 4 groups (A to D), has been refined to use only respiratory symptoms and history of exacerbations.

  • The pharmacological management of ongoing COPD has been completely revised, with strategies for escalation and de-escalation of treatment.

  • Inhaled corticosteroids are now only recommended if patients with ongoing COPD experience further exacerbations while on long-acting bronchodilators, or in those with likely asthma-COPD overlap.

See Management: approach

Original source of update



History and exam

Key diagnostic factors

  • presence of risk factors (e.g., smoking)
  • cough
  • shortness of breath

Other diagnostic factors

  • barrel chest
  • hyper-resonance on percussion
  • distant breath sounds on auscultation
  • poor air movement on auscultation
  • wheezing on auscultation
  • coarse crackles
  • tachypnoea
  • asterixis
  • distended neck veins
  • lower-extremity swelling
  • fatigue
  • headache
  • cyanosis
  • loud P2
  • hepatojugular reflux
  • hepatosplenomegaly
  • clubbing

Risk factors

  • cigarette smoking
  • advanced age
  • genetic factors
  • white ancestry
  • exposure to air pollution or occupational exposure
  • developmentally abnormal lung
  • male gender
  • low socio-economic status

Diagnostic investigations

1st investigations to order

  • spirometry
  • pulse oximetry
  • ABG
  • CXR
  • FBC
  • ECG
Full details

Investigations to consider

  • sputum culture
  • PFTs
  • chest CT scan
  • alpha-1 antitrypsin level
  • exercise testing
  • sleep study
  • respiratory muscle function
Full details

Treatment algorithm


Authors VIEW ALL

Manoochehr Abadian Sharifabad

Fountain Valley Regional Medical Center

Fountain Valley



MAS declares that he has no competing interests.

Dr Manoochehr Abadian Sharifabad would like to gratefully acknowledge Dr Jonathan P. Parsons and Dr Michael Ezzie, the previous contributors to this monograph. JPP has contributed at speakers' bureaus for GlaxoSmithKline, Inc., Schering-Plough, Inc., and AstraZeneca, Inc. ME declares that he has no competing interests.

Peer reviewers VIEW ALL

Hackensack University Medical Center




HA declares that he has no competing interests.

Assistant Professor of Medicine

National Jewish Medical and Research Center

University of Colorado Health Sciences Center




WJ declares that he has no competing interests.

Associate Professor

Director of Respiratory Medicine

Eastern Health & Monash University




FT declares that he has no competing interests.

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