Updated international guideline on the diagnosis and management of COPD
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released the 2021 version of its comprehensive report on the diagnosis and management of COPD. New information on chronic management includes:
A new recommendation about the tetanus/diphtheria/pertussis vaccine
Reference to the World Health Organization (WHO) minimum set of interventions for the management of COPD
Updated findings on triple therapy and mortality
New evidence on mucolytic therapy
New evidence on pharmacist-led and lay health coaching for inhaler technique
New evidence on acupuncture and acupressure for the palliative treatment of dyspnoea.
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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
- white ancestry
- exposure to air pollution
- exposure to burning solid or biomass fuel
- occupational exposure to dusts, chemicals, vapors, fumes, or gases
- developmentally abnormal lung
- 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
Fountain Valley Regional Medical Center
Fountain Valley
CA
Disclosures
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
Hackensack University Medical Center
Hackensack
NJ
Disclosures
HA declares that he has no competing interests.
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.
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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