Chronic Obstructive Pulmonary Disease (COPD)

We recommend that spirometry, demonstrating airflow obstruction (postbronchodilator forced expiratory volume in one second/forced vital capacity [FEV1/FVC] <70%, with age adjustment for more elderly individuals), be used to confirm all initial diagnoses of chronic obstructive pulmonary disease (COPD). (Strong for)

We have no recommendations regarding utilization of existing clinical classification systems at this time. ()

We suggest classification of patients with COPD into two groups: (Weak for)

We recommend offering prevention and risk reduction efforts including smoking cessation and vaccination. (Strong for)

We recommend investigating additional comorbid diagnoses particularly in patients who experience frequent exacerbations (two or more/year, defined as prescription of corticosteroids, prescription of antibiotics, hospitalization, or ED visit) using simple tests and decision rules (cardiac ischemia [troponin, electrocardiogram], congestive heart failure [B-type natriuretic peptide (BNP), pro-BNP], pulmonary embolism [D-dimer plus clinical decision rule], and gastroesophageal reflux). (Strong for)

We suggest that patients with COPD and signs or symptoms of a sleep disorder have a diagnostic sleep evaluation. (Weak for)

We suggest that patients presenting with early onset COPD or a family history of early onset COPD be tested for alpha-1 antitrypsin (AAT) deficiency. (Weak for)

We recommend that patients with AAT deficiency be referred to a pulmonologist for management of treatment. (Strong for)