Opportunistic case finding pivotal in diagnosing COPD.

The principle of COPD diagnosis is based on establishing the presence of obstructive post-bronchodilator spirometry in an at-risk individual with appropriate symptoms. Most individuals diagnosed with COPD have substantial cigarette smoke exposure, more than 10 and usually 20 pack years. Patients with COPD usually have symptoms of cough and phlegm, exertional breathlessness, wheezing, recurrent winter bronchitis or a combination of these symptoms. A current or ex-smoker, aged over 35, with respiratory symptoms should undergo spirometry testing. The hallmark of COPD is the presence of airflow obstruction after administration of a bronchodilator. However, while normal spirometry excludes COPD, obstructive spirometry is also seen in asthma and bronchiectasis emphasising the importance of clinical features. A significant change introduced in the 2010 NICE guideline is the new grading of COPD severity. A system based on FEV alone oversimplifies disease severity and full clinical assessment should include symptoms, frequency of exacerbations and impact of disease on functioning and health status. The most important single intervention is smoking cessation as this is proven to reduce decline in FEV1 and reduce mortality. All patients should also receive influenza and pneumococcal vaccination, weight management, pulmonary rehabilitation (if breathless) and short-acting bronchodilators. The evidence base for rehabilitation is very strong with positive effects shown on breathlessness, exercise capacity, activity level, exacerbation rate, leg muscle strength and quality of life.