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Health Protocols

Chronic Obstructive Pulmonary Disease (COPD)


Physicians typically consider COPD in patients with chronic cough, sputum production, shortness of breath, decreased exercise tolerance, and a history of exposure to tobacco smoke (GOLD 2011).

Early in the disease, physical examination(s) may be normal. Later in the disease, however, the classic "barrel chest" may occur due to residual air trapped in the lungs, leading to their hyperinflation. In addition, the increased effort required to exhale can produce wheezing, while pursed lips or grunting respirations may signal efforts to keep the airways open by increasing pressure at the beginning of expiration (Crawford 2008; GOLD 2011; ICSI 2011). Also, severe to very severe COPD commonly results in fatigue, weight loss and anorexia (GOLD 2011).

Spirometry is the gold standard for diagnosing and monitoring progression of COPD. This breathing test includes forced expiratory volume in one second (FEV1) - the greatest volume of air that can be breathed out in the first second of a large breath, and the forced vital capacity (FVC) - the greatest volume of air that can be breathed out in a whole large breath. In healthy people, at least 70% of the FVC comes out in the first second (i.e., the FEV1/FVC ratio is >70%). In fact, the FEV1/FVC ratio <70% is a diagnostic characteristic of COPD (Nathell 2007; GOLD 2011).

Other tests (e.g., x-rays, computed tomography, and magnetic resonance imaging) may be performed if complications such as pneumonia are suspected.

The serum alpha-1-antitrypsin level may also be measured to detect alpha-1-antitrypsin deficiency. This testing may be especially considered for individuals of northern European descent with a personal history of COPD before age 50, family history of COPD or emphysema, and limited exposure to inhalants or irritants (Serapinas 2012; American Lung Assc. 2011; Merck Manual 2008).

Exacerbations of COPD often develop following a viral upper respiratory or tracheal infection. Assessment of COPD exacerbations is based upon the degree of airflow limitation, duration or worsening of new symptoms, and number of previous episodes. Clinical tests (e.g., electrocardiography, blood count, and presence of infections) may also be performed to assess the severity of an exacerbation (GOLD 2011).