Further assess Categories A & C:

By vgreene, 6 November, 2014
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<sup>1</sup> Lung volumes not essential to pt mgmt. DLCO helpful in pts w/ SOB out of proportion to airflow limitation.<br><br>
<sup>2</sup> Exacerbation = acute worsening (beyond day-to-day variation) leading to change in medication.
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<sup>3</sup> Comorbidities: CV dz, muscle dysfxn, osteoporosis, anxiety, depression, asthma-COPD overlap, DM, lung CA, GERD, etc. Identify/manage comorbidities in same way as for pts w/o COPD.
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<sup>4</sup> Physical activity monitoring may be more relevant to prognosis than exercise capacity eval.
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<sup>5</sup> The most common 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. <a href=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2487011/pdf/bullwho00396-0013.pdf>PDF</a>
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<sup>6</sup> A1AT-deficiency pts typically present <45 yo w/ lower lobe emphysema.
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If FEV1
Imaging: CXR not useful for COPD dx; may exclude alternative dx or establish resp/CV comorbidities. CT not routine; may help DDx if COPD in doubt
Routinely assess comorbidities3
If assessing disability: Paced shuttle walk test or unpaced 6-min walk test.4 Cycle/treadmill ergometry used to eval coexisting/alternative dx (eg, CV dz)
If ancestry from particularly high-prevalent A1AT-deficiency area:5 WHO recommends A1AT test6
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Further assess Categories A & C: