Synopsis
Confirm persistent airflow obstruction in the correct clinical context, describe disease impact beyond FEV1, and identify alternative diagnoses, alpha-1 antitrypsin deficiency and complications that change management.
- Think COPD in adults over 35 with smoking or occupational exposure plus exertional breathlessness, chronic cough, regular sputum, frequent winter bronchitis or wheeze.
- Confirm with quality-assured post-bronchodilator spirometry showing FEV1/FVC below 0.70 in the appropriate clinical context.
- A fixed ratio can overdiagnose older adults and miss some younger adults; use the lower limit of normal and diagnostic review when symptoms and ratio disagree.
Key red flags
Clubbing, focal signs, haemoptysis, very large sputum volume, systemic features, rapid decline or disproportionate hypoxaemia suggests cancer, bronchiectasis, ILD, TB, heart failure or pulmonary vascular disease.
Investigation priorities
Confirm persistent airflow obstruction.
Management branches
Compatible symptoms and exposure history.
- Take exposure, symptom, exacerbation, childhood/asthma, occupational and family history; examine for wheeze, hyperinflation, cyanosis, oedema, cachexia, clubbing and cardiac disease.
- Perform quality-assured post-bronchodilator spirometry when stable. Confirm persistent obstruction only when FEV1/FVC below 0.70 fits the syndrome; review LLN in borderline or age-discordant cases.
Key medicines
Nicotine replacement combinationExample: nicotine patch delivering 21 mg/24 h daily for heavier dependence plus a rapid product such as 2 mg gum or lozenge when cravings occur; taper over roughly 8-12 weeks according to response and product directions.
Salbutamol symptom reliever while full plan is established100-200 micrograms inhaled when required, commonly 1-2 actuations of a 100 microgram pMDI; frequency and maximum follow the specific SmPC.