Last reviewed: 25 Apr 2022
Last updated: 20 Dec 2021
20 Dec 2021

Updated GOLD guidance includes new guidance on vaccination, diffusing capacity of the lungs for carbon monoxide (DLCO) testing, and lung cancer screening

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released the 2022 version of its comprehensive report on the diagnosis, management, and prevention of COPD. Updated information includes:

  • Use of DLCO testing for diagnosis in the field

  • A systematic review showing that, compared with placebo, pharmacological treatment for COPD can reduce the rate of decline in FEV1 by 5.0 mL/year

  • Updated vaccination recommendations from the US Centers for Disease Control and Prevention (CDC): coronavirus disease 2019 (COVID-19) vaccine for all people with COPD, and varicella-zoster (shingles) vaccine for those aged ≥50 years

  • A recommendation for annual low-dose CT scanning for lung cancer in patients with COPD due to smoking (in line with US Preventive Services Task Force recommendations).

See Epidemiology

See Diagnosis: approach

See Management: emerging

See Management: approach

See Management: prevention

Original source of update



History and exam

Key diagnostic factors

  • cough
  • shortness of breath
  • sputum production
  • exposure to risk factors

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
  • weight loss
  • muscle loss
  • headache
  • pursed lip breathing
  • cyanosis
  • loud P2
  • hepatojugular reflux
  • hepatosplenomegaly
  • clubbing

Risk factors

  • cigarette smoking
  • advanced age
  • genetic factors
  • lung growth and development
  • white ancestry
  • exposure to air pollution
  • exposure to burning solid or biomass fuel
  • occupational exposure to dusts, chemicals, pesticides, vapors, fumes, or gases
  • male sex
  • low socio-economic status
  • rheumatoid arthritis

Diagnostic investigations

1st investigations to order

  • spirometry
  • standardised symptoms score
  • pulse oximetry
  • ABG
  • CXR
  • FBC
  • ECG

Investigations to consider

  • pulmonary function tests
  • chest CT scan
  • serial peak flow measurement
  • sputum culture
  • alpha-1 antitrypsin level
  • exercise testing
  • sleep study
  • respiratory muscle function
  • echocardiogram

Treatment algorithm



Manoochehr Abadian Sharifabad, MD
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 topic. 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

Hormoz Ashtyani, MD, FCCP

Hackensack University Medical Center




HA declares that he has no competing interests.

William Janssen, MD

Assistant Professor of Medicine

National Jewish Medical and Research Center

University of Colorado Health Sciences Center




WJ declares that he has no competing interests.

Francis Thien, MD, FRACP, FCCP

Associate Professor

Director of Respiratory Medicine

Eastern Health & Monash University




FT declares that he has no competing interests.

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