¹ Lung volumes help characterize severity, but they are not essential to pt mgmt. DLCO helpful to assess functional impact of emphysema and in pts w/ SOB out of proportion to airflow limitation. Degree of reversibility pre/post-BD not shown to improve COPD dx; differentiate from asthma, or predict response to tx. Significant lung pathology can be present w/o airflow limitation.

² When community prevalence of COVID-19 high, restrict spirometry to pts requiring test for dx of COPD and/or assessment of lung fxn for interventional/surgical procedures.

³ A1AT-deficiency pts classically present <45 yo w/ panlobular lower lobe emphysema.

⁴ Sx may vary day to day. Dyspnea/cough/sputum may precede airflow limitation by yrs. Airflow limitation may exist w/o dyspnea/cough/sputum and vice versa. Dyspnea=increased breathing effort, heaviness, air hunger, gasping, etc. May be progressive, persistent, worse w/ exercise. Cough may be intermittent, unproductive, or absent. Sputum ≥3mo in each of 2 consecutive yrs (not otherwise explained)=chronic bronchitis; however, sputum in COPD varies. Pts may swallow sputum; large volumes may indicate bronchiectasis. Purulence only weakly correlates to presence of bacteria. Wheezing and chest tightness are nonspecific, and may or may not be present. Fatigue or anorexia may accompany severe dz.

Cough DDx: asthma, CA, TB, HF, CF, bronchiectasis, allergic rhinitis, UACS (postnasal drip), GERD, ACEI/other meds, interstitial lung dz, idiopathic cough.

⁵ Exam: Wheeze (laryngeal or chest) does not confirm asthma; absence does not exclude COPD. Ankle swelling may signal cor pulmonale.

⁶ Childhood factors include low birth weight, resp infxns in childhood.

⁷ Exacerbation=acute worsening (beyond day-to-day variation) leading to additional tx. Hospitalization=for COPD.

⁸ Common comorbidities include CV dz, skeletal muscle dysfxn, metabolic syndrome, osteoporosis, depression, anxiety, lung CA. Pseudomonas aeruginosa colonization independently ↑risk of hospitalization and all-cause mortality.

⁹ Physical activity monitoring may be more relevant to prognosis than exercise capacity eval.

¹⁰ The most common gene variant has highest frequency in Scandinavia, predominantly occurring in white populations of European origins (especially northern), absent from Asian and Black populations. Alpha-1 Antitrypsin Deficiency - Memorandum from a WHO Meeting. Bulletin of the World Health Organization. 1997;75:397-415. PDF