. 2019 Feb 20;3(1):bjgpopen18X101632. doi: 10.3399/bjgpopen18X101632

Box 4. An outline of screening and diagnosis protocols for asthma and COPD (extracted from case management desk-guide).

	Asthma	COPD
Screening	Asthma is indicated, if: younger patient (though can be an older adult) patient and/or family has history of asthma, allergic rhinitis (hay fever), or eczema patient complains of: recurrent episodes of dry cough and/or difficulty breathing, more so at night or in the morning worsening with exercise, cold, dust, seasonal allergens, or drugs	COPD is indicated, if: middle-aged or older adult who smokes or used to smoke patient has a history of recurrent chest infection patient complains of: progressive persistent shortness of breath (rather than episodic) cough (productive and persistent) exercise worsening the symptoms.
Assess for asthma or COPD diagnosis, if one or more of the above indications.
Diagnosis	Diagnose asthma, if patient has history of ≥1 asthma indications, and during an exacerbation has: wheeze (widespread and more on expiration) on investigation (may be normal): PEFR during an exacerbation <80% which improves with bronchodilator other supporting/ indicative investigations: blood CP (eosinophil >5%, though also in bronchitis and COPD) chest X-rays (not usually indicated; may be normal, may be hyperinflation)	Diagnose COPD, if patient has history of ≥1 COPD indications, and has: wheeze – widespread and more on expiration on investigation: PEFR during an exacerbation <80%, with minor or no change with bronchodilator other supporting/ indicative investigations: blood CP (to check for anemia and polycythemia, if required) chest X-rays (vertical heart, hyperinflated lungs, low-set diaphragm)

Asthma

COPD

Screening

Asthma is indicated, if:

younger patient (though can be an older adult)
patient and/or family has history of asthma, allergic rhinitis (hay fever), or eczema
patient complains of:
- recurrent episodes of dry cough and/or difficulty breathing, more so at night or in the morning
- worsening with exercise, cold, dust, seasonal allergens, or drugs

COPD is indicated, if:

middle-aged or older adult who smokes or used to smoke
patient has a history of recurrent chest infection
patient complains of:
- progressive persistent shortness of breath (rather than episodic)
- cough (productive and persistent)
- exercise worsening the symptoms.

Assess for asthma or COPD diagnosis, if one or more of the above indications.

Diagnosis

Diagnose asthma, if patient has history of ≥1 asthma indications, and during an exacerbation has:

wheeze (widespread and more on expiration)
on investigation (may be normal):

PEFR during an exacerbation <80% which improves with bronchodilator
other supporting/ indicative investigations:

blood CP (eosinophil >5%, though also in bronchitis and COPD)
chest X-rays (not usually indicated; may be normal, may be hyperinflation)

Diagnose COPD, if patient has history of ≥1 COPD indications, and has:

wheeze – widespread and more on expiration
on investigation:

PEFR during an exacerbation <80%, with minor or no change with bronchodilator
other supporting/ indicative investigations:

blood CP (to check for anemia and polycythemia, if required)
chest X-rays (vertical heart, hyperinflated lungs, low-set diaphragm)

COPD = chronic obstructive pulmonary disease. Blood CP = blood complete picture. PEFR = peak expiratory flow rate.