From the Guidelines
Chronic Obstructive Pulmonary Disease (COPD) typically presents with symptoms such as dyspnea, cough, and/or sputum production, which are often underreported by patients 1. The primary symptoms of COPD include:
- Persistent cough with mucus production
- Shortness of breath (especially during physical activity)
- Wheezing
- Chest tightness Many patients experience frequent respiratory infections and may have morning headaches from retained carbon dioxide. As COPD progresses, patients often develop exertional dyspnea that eventually occurs even at rest, chronic fatigue, unintended weight loss, and swelling in the ankles, feet, or legs due to right heart failure. Cyanosis (bluish discoloration of lips or fingernail beds) may appear in advanced stages. According to the 2018 GOLD report, the diagnosis of COPD requires three features: a postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of less than 0.70, appropriate symptoms including dyspnea, chronic cough, sputum production, or wheezing, and significant exposures to noxious stimuli such as a history of smoking cigarettes, or other environmental exposures 1. The most recent and highest quality study, the 2018 GOLD report, emphasizes the importance of high-quality spirometry in diagnosing COPD, which is essential for accurate diagnosis but is often underused in clinical practice 1. Early recognition of these symptoms is crucial as prompt treatment can slow disease progression and improve quality of life. The goals of COPD management aim to improve symptoms, lung function, and health status and to reduce exacerbations, disease progression, and mortality 1.
From the Research
Signs and Symptoms of COPD
- Dyspnea at rest or with exertion 2
- Chronic cough with or without sputum production 2
- History of wheezing 2
- Diminished breath sounds 2
- Peak flow rate less than 350 L per minute 2
- Smoking history of more than 40 pack-years 2
- Age older than 45 years 2
- Acute exacerbations characterized by worsening dyspnea, increased cough, sputum, and/or sputum purulence 3
Clinical Predictors of COPD
- Combination of three clinical variables: peak flow rate less than 350 L per minute, diminished breath sounds, and a smoking history of 30 pack-years or more 2
- Maximal laryngeal height 2
- Self-reported history of COPD 2
Diagnosis and Management of COPD
- Diagnosis should be suspected in patients with risk factors and confirmed by spirometry to detect airflow obstruction 2
- Pharmacotherapy and smoking cessation are the mainstays of treatment 2
- Pulmonary rehabilitation, long-term oxygen therapy, and surgery may be considered in select patients 2
- Current guidelines recommend starting monotherapy with an inhaled bronchodilator, stepping up to combination therapy as needed, and/or adding inhaled corticosteroids as symptom severity and airflow obstruction progress 2