From the Guidelines
The diagnosis of COPD should be based on a combination of clinical evaluation and spirometry, with a post-bronchodilator FEV1/FVC ratio less than 0.7 confirming the presence of persistent airflow limitation, as recommended by the GOLD Science Committee in 2025 1. The clinical criteria for COPD include characteristic symptoms such as:
- Chronic and progressive dyspnea
- Cough
- Sputum production Along with a history of exposure to risk factors, particularly cigarette smoking. COPD severity is classified based on spirometry results, with the following stages:
- GOLD 1 (mild) with FEV1 ≥ 80% predicted
- GOLD 2 (moderate) with FEV1 50-79% predicted
- GOLD 3 (severe) with FEV1 30-49% predicted
- GOLD 4 (very severe) with FEV1 < 30% predicted Assessment should also include evaluation of symptom burden using validated questionnaires like the COPD Assessment Test (CAT) or Modified Medical Research Council (mMRC) dyspnea scale, and exacerbation history, as outlined in the 2017 GOLD report 1. This comprehensive approach allows for proper classification of patients into groups that guide treatment decisions, ultimately improving morbidity, mortality, and quality of life outcomes. The use of pre- and post-bronchodilator spirometry is crucial in diagnosing COPD, and the GOLD Science Committee's recommendations should be followed to ensure accurate diagnosis and treatment, as supported by the most recent evidence 1.
From the Research
COPD Clinical Criteria
The clinical criteria for Chronic Obstructive Pulmonary Disease (COPD) include:
- A postbronchodilator forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio of 0.7 or less in a patient with dyspnea, chronic cough or sputum production, and a history of irritant exposure 2
- Symptoms such as dyspnea at rest or with exertion, chronic cough with or without sputum production, or a history of wheezing 3
- Risk factors, primarily a history of smoking, with a smoking history of more than 40 pack-years being a significant indicator 3
- Physical examination findings, including maximal laryngeal height, and age older than 45 years 3
- Peak flow rate less than 350 L per minute, diminished breath sounds, and a smoking history of 30 pack-years or more 3
Diagnostic Value of History and Physical Examination
The diagnostic value of history and physical examination for COPD includes:
- History items such as dyspnea, wheezing, previous consultation for wheezing or cough, self-reported COPD, age, and smoking 4
- Physical examination items such as wheezing, forced expiratory time, laryngeal height, and prolonged expiration 4
- However, there is insufficient evidence to assess the value of history taking and physical examination for diagnosing COPD 4
Pulmonary Function Tests
Pulmonary function tests, such as spirometry, are required for the diagnosis and follow-up of COPD patients 5
- The diagnosis of COPD relies on the presence of chronic airflow limitation poorly reversible or not reversible at all, defined by an FEV1/FVC ratio less than 70% 5
- Stages of severity of COPD are defined according to the level of post-bronchodilator FEV1, with thresholds of > 80% (stage I), 50-80% (stage II), 30-50% (stage III), and < 30% (stage IV) 5
Predicting 5-Year Survival
The best thresholds of FEV1 and dyspnea to predict 5-year survival in COPD patients are: