Last reviewed: 22 Mar 2021
Last updated: 18 Dec 2020
18 Dec 2020

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.  

See Management: approach

Original source of updateexternal link opens in a new window



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


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 reviewersVIEW 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.

Use of this content is subject to our disclaimer