COPD
Confirm diagnosis with spirometry, assess severity, and start maintenance therapy.
Last reviewed January 5, 2026
Red flags
- Acute exacerbation with hypoxia, confusion, or severe work of breathing.
- Hemoptysis, unexplained weight loss, or suspected lung cancer.
Diagnosis
- Suspect COPD in patients with chronic dyspnea, cough, or sputum and risk factors.
- Confirm airflow limitation with spirometry after bronchodilator.
Initial workup
- Document symptom burden (CAT or mMRC), exacerbation history, and smoking status.
- Review vaccinations, inhaler technique, and comorbidities (cardiac disease, anxiety).
First-line management
- Smoking cessation support and vaccinations (influenza, pneumococcal).
- Start long-acting bronchodilator therapy based on symptom burden and exacerbations.
- Refer to pulmonary rehab and teach inhaler technique.
Referral triggers
- Frequent exacerbations despite optimized inhalers.
- Need for long-term oxygen, uncertain diagnosis, or advanced therapies.
References
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