Chronic obstructive pulmonary disease (COPD)
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).
Summary
Definition
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
Contributors
Authors
Manoochehr Abadian Sharifabad, MD
Fountain Valley Regional Medical Center
Fountain Valley
CA
Disclosures
MAS declares that he has no competing interests.
Acknowledgements
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.
Disclosures
ME declares that he has no competing interests.
Peer reviewers
Hormoz Ashtyani, MD, FCCP
Hackensack University Medical Center
Hackensack
NJ
Disclosures
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
Denver
CO
Disclosures
WJ declares that he has no competing interests.
Francis Thien, MD, FRACP, FCCP
Associate Professor
Director of Respiratory Medicine
Eastern Health & Monash University
Victoria
Australia
Disclosures
FT declares that he has no competing interests.
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