From the Guidelines
When taking a history for COPD, it is crucial to focus on a comprehensive medical history that includes exposure to risk factors, past medical history, family history, pattern of symptom development, history of exacerbations, presence of comorbidities, and impact of disease on patient’s life, as outlined in the 2017 GOLD executive summary 1.
Key Components of COPD History Taking
- Exposure to risk factors such as smoking and occupational or environmental exposures
- Past medical history, including asthma, allergy, sinusitis, or nasal polyps; respiratory infections in childhood; other chronic respiratory and nonrespiratory diseases
- Family history of COPD or other chronic respiratory diseases
- Pattern of symptom development: age of onset, type of symptom, more frequent or prolonged “winter colds,” and social restriction
- History of exacerbations or previous hospitalizations for a respiratory disorder
- Presence of comorbidities, such as heart disease, osteoporosis, musculoskeletal disorders, and malignancies
- Impact of disease on patient’s life, including limitation of activity, missed work and economic impact, and feelings of depression or anxiety
- Social and family support available to the patient
- Possibilities for reducing risk factors, especially smoking cessation
Importance of Comorbidities
COPD is frequently associated with one or more comorbidities and/or systemic effects, which can complicate management and affect patient outcomes, as noted in a 2015 statement by the American Thoracic Society and European Respiratory Society 1.
- Ischemic heart disease is a common comorbidity that contributes to worsening health and functional status
- Other comorbidities such as lung cancer, diabetes, hypertension, and cardiovascular diseases are also prevalent in patients with COPD
- Acute exacerbations of respiratory symptoms in patients with COPD may be caused by extrapulmonary mechanisms and exacerbations of concomitant chronic diseases
Comprehensive Approach
A comprehensive approach to COPD history taking, as recommended by the 2017 GOLD executive summary 1, helps establish disease severity, guides treatment decisions, and identifies modifiable risk factors to improve patient outcomes.
- Assessing functional limitations using validated tools like the modified Medical Research Council (mMRC) dyspnea scale or COPD Assessment Test (CAT)
- Reviewing current medications and oxygen therapy
- Exploring comorbidities and their impact on COPD management
- Identifying possibilities for reducing risk factors, especially smoking cessation, to improve patient outcomes.
From the Research
COPD History Taking
When taking a history for COPD, several key points should be considered:
- A significant smoking history is a major risk factor for COPD, with more than 40 pack-years increasing the likelihood of the disease 2
- Symptoms such as dyspnea, cough, and sputum production are common in COPD patients 3, 4
- A history of wheezing may also be present in some patients 2
- The diagnosis of COPD should be suspected in patients with a history of smoking and symptoms such as dyspnea, cough, and sputum production 3, 2
Risk Factors
Several risk factors can increase the likelihood of COPD:
- Smoking history: more than 40 pack-years 2
- Age: older than 45 years 2
- Self-reported history of COPD 2
- Maximal laryngeal height 2
- Peak flow rate less than 350 L per minute 2
- Diminished breath sounds 2
Diagnosis
The diagnosis of COPD is made by:
- Spirometry: a forced expiratory volume in the first second of expiration to forced vital capacity (FEV1/FVC) ratio of less than 0.7 after bronchodilator administration confirms the diagnosis 3
- Symptoms and physical examination findings, such as dyspnea, cough, and sputum production, can also support the diagnosis 2, 4
Treatment
Treatment for COPD typically involves:
- Bronchodilators: long-acting beta2-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs) 3, 4
- Inhaled corticosteroids: may be added to LABA-LAMA therapy for patients with continued exacerbations 3, 4
- Pulmonary rehabilitation: improves symptoms and exercise tolerance 4
- Supplemental oxygen: for patients with resting hypoxemia 4