| Clinical interview |
| GOLD 2013 |
COPD assessment must consider the following aspects of the disease separately: current level of patient’s symptoms, severity of the spirometric abnormality, exacerbation risk, presence of comorbidities |
| GesEPOC 2012 |
The clinical phenotype of COPD should be established in all patients. GesEPOC sets four different clinical phenotypes: A) non-frequent exacerbator, with emphysema or chronic bronchitis; B) COPD-asthma overlap; C) emphysema frequent exacerbator; and D) chronic bronchitis frequent exacerbator. |
| GesEPOC 2012 |
The diagnosis of COPD is based on a decrease in the expiratory flow, measured by FEV1 and its ratio to the forced vital capacity (FEV1/FVC). |
| GOLD 2013 |
At each visit, inquire about changes in symptoms since the last visit, including cough and sputum, breathlessness, fatigue, activity limitation, and sleep disturbances. |
| GOLD 2013 |
GOLD recommends the use of the Modified British Medical Research Council (mMRC) questionnaire or the COPD Assessment Test (CAT). |
| GesEPOC 2012 |
The severity of a patient with COPD is determined by the BODE index. Alternatively, the BODEx index can be used for patients with mild-to-moderate COPD. |
| GOLD 2013 |
Comorbidities should be looked for routinely, and treated appropriately, in any patient with COPD. |
| GOLD 2013 |
At each visit, determine current smoking status and smoke exposure |
| GOLD 2013 |
Dosages of various medications, adherence to the regimen, inhaler technique, effectiveness of the current regime at controlling symptoms, and side effects of treatment should be monitored. |
| Complementary tests: spirometry |
| GOLD 2013 |
Decline in lung function is best tracked by spirometry performed at least once a year to identify patients whose lung function is declining quickly |
| GOLD 2013 |
Spirometry should be performed after the administration of an adequate dose of a short-acting inhaled bronchodilator in order to minimize variability. |
| Complementary tests: chest X-ray |
| GOLD 2013 |
A chest X-ray is not useful to establish a diagnosis in COPD, but it is valuable in excluding alternative diagnoses and establishing the presence of significant comorbidities |
| GesEPOC 2012 |
A chest X-ray should be performed for initial assessment and to rule out the presence of complications: sudden dyspnea of unexplained origin (pneumothorax), changes in the pattern of cough or hemoptysis (neoplasia), or suspected pneumonia. |
| Complementary tests: Computed tomography (CT) |
| GOLD 2013 |
Computed tomography (CT) of the chest is not routinely recommended. However, when there is doubt about the diagnosis of COPD, CT scanning might help in the differential diagnosis where concomitant diseases are present. |
| GesEPOC 2012 |
Indications for a chest CT scan: frequent exacerbator phenotype for the diagnosis of bronchiectasis, exclusion of other associated lung diseases, diagnosis and evaluation of emphysema |
| Complementary tests: Lung volumes and diffusing capacity |
| GOLD 2013 |
Lung Volumes and Diffusing Capacity help characterize the severity of COPD but are not essential to patient management |
| SEPAR 2009 |
Patients with severe or very severe COPD should undergo the following tests at least one time: measurement of static lung volumes and carbon monoxide diffusing capacity |
| GesEPOC 2012 |
Indication for lung volumes determination: suspected restrictive component or grades III–IV obstruction for investigating lung hyperinflation |
| GesEPOC 2012 |
Indication for diffusing capacity determination: grades III–IV obstruction, hypoxia or severe dyspnea not proportional to the degree of obstruction, investigation of emphysema |
| Complementary tests: Pulse oximetry and arterial blood gases analysis |
| GOLD 2013 |
Pulse oximetry should be used to assess all stable patients with FEV1 <35% predicted or with clinical signs suggestive of respiratory failure or right heart failure |
| GesEPOC 2012 |
Pulse oximetry is useful in the evaluation of suspected hypoxemia, either in seriously ill patients or for the treatment of exacerbations |
| GOLD 2013 |
If peripheral saturation is <92% arterial blood gases should be assessed |
| GesEPOC 2012 |
Indications for arterial blood gas analysis: grades III–IV obstruction or FEV1 <1 L, MRC dyspnea 3–4, signs of pulmonary hypertension and/or cor pulmonale, indication and monitoring of patients with OCD, hematocrit >55%, cyanosis and/or pulse oximetry <92% |
| Complementary tests: Alpha1-antitrypsin |
| GOLD 2013 |
The World Health Organization recommends that COPD patients from areas with a particularly high prevalence of alpha-1 antitrypsin deficiency should be screened for this genetic disorder |
| SEPAR 2009 |
Plasma α1-antitrypsin concentrations should be determined for all COPD patients at least one time |
| GesEPOC 2012 |
In all patients with COPD plasma concentration of alpha-1-antitrypsin should be determined at least one time |
| Complementary tests: Exercise test and physical activity |
| GOLD 2013 |
Objectively measured exercise impairment, assessed by a reduction in self-paced walking distance or during incremental exercise testing in a laboratory, is a powerful indicator of health status impairment and predictor of prognosis |
| GOLD 2013 |
Monitoring of physical activity may be more relevant regarding prognosis than evaluating exercise capacity |
| SEPAR 2009 |
Patients with severe or very severe COPD should undergo the following test at least one time: maximal exercise test |
| GesEPOC 2012 |
Indications for 6-min walking test: calculate BODE index, obstruction grades III-IV, prior to the evaluation for respiratory rehabilitation |
| GesEPOC 2012 |
Indications for maximal exercise test: evaluation for pulmonary rehabilitation |
| Nutritional assessment |
| SEPAR 2009 |
Patients with severe or very severe COPD should undergo the following test at least one time: nutritional assessment |
