5 questions to ask a patient when suspecting COPD

Chronic obstructive pulmonary disease (COPD) is a common, but underdiagnosed condition that causes persistent breathing difficulties due to long-term lung damage. Commonly affecting middle-aged and older smokers, COPD encompasses conditions like emphysema and chronic bronchitis, which progressively worsen over time. Although there is currently no cure for COPD, early detection and treatment can greatly help manage symptoms. In this blog, we will explore what COPD is, its symptoms, causes and detection methods, as well as key questions to ask the patient when assessing a potential case.

In this blog you will learn:

• What is COPD and why should it be detected early?
• What are the symptoms of COPD?
• What are the causes of COPD?
• How is COPD diagnosed?

What is COPD and why should it be detected early?

Chronic obstructive pulmonary disease (COPD) is an incurable, progressive chronic lung disorder.

It is a mixture of a number of conditions; chronic bronchitis and emphysema are the most prominent. They have similar symptoms but affect different parts of the lungs. Chronic bronchitis affects the airways (the tubes that enable air to go in and out of the lungs) while emphysema affects the alveoli (the air sacs at the end of the airways), causing their walls to rupture. This creates larger airspaces, reducing the amount of oxygen that reaches the bloodstream.

In 2020, the global prevalence of COPD was estimated at 480 million cases. [4] COPD is underdiagnosed and this should change for a number of reasons. First of all, COPD represents the fourth leading cause of death worldwide. [5] Secondly, early treatment can greatly alleviate its symptoms.

What are the symptoms of COPD?

The patient experiences growing respiratory problems and airflow limitation. In numerous patients, chronic cough (with or without sputum production) can appear years before the airflow gets limited. Other symptoms include chest tightness, fatigue, and chronic and progressive shortness of breath (dyspnea).

It should be noted that COPD symptoms overlap with those of other conditions. For example, shortness of breath and cough are also symptoms of COVID-19, pneumonia or asthma. [6] [7]

What are the causes of COPD?

The key preventable risk factor is smoking. Other causes include environmental or occupational exposure to irritants, extreme heat or cold as well as genetic conditions: protein alpha 1-antitrypsin (AAT) deficiency affects the body’s ability to produce this protein, which protects the lungs.

Triggers for COPD exacerbations: viral or bacterial infections in half of the cases, and environmental factors in the other half.

How is COPD diagnosed?

Medical history

The patient should be asked about their family history, the presence of causes/risk factors, and the development of the symptoms.

Questionnaires

Different countries use a variety of questionnaires. Some of them are international, such as the mMRC and CAT tests.

The Modified British Medical Research Council (mMRC) Questionnaire assesses breathlessness – from grade 0 (breathlessness with strenuous exercise only) to grade 4 (affecting daily activities, including the ability to go out of the house). COPD Assessment Test (CAT) assesses the effect of COPD on the patient’s daily functioning, with scores from 0 to 40.

If a patient reaches a certain score, they are sent for a spirometry examination.

Below is a short but highly useful questionnaire issued by the HAS (Haute Autorité de Santé), an independent health authority in France. It consists of just 5 questions. [8]

5 questions to ask a patient when suspecting COPD

Do you often cough (every day)?

Do you often have a productive cough or cough up phlegm?

Are you short of breath faster than others your age?

Are you older than 40?

Are you a current or former smoker – or have you been exposed for a longer period or repeatedly to gases, dust, smoke or fumes at your workplace?

In the case of 3 positive answers, the HAS requires that the patient takes a spirometry exam.  

Official diagnosis of COPD

Spirometry is used for measuring airflow limitation. It is essential in discovering COPD at its early stage, i.e. before obvious symptoms appear. In this, bronchodilators (medications used to relax bronchial muscles) are used, so the air can pass through the lungs more easily. [9]

An official diagnosis of COPD is made on the basis of post-bronchodilator FEV1/FVC <0.70; this shows persistent airflow limitation. [11]

Post-bronchodilator FEV1/FVC (FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity) shows the severity of airflow limitation. On its basis, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines classify patients into four categories [10]:

The biggest COPD challenge in primary care is detecting it in its early stages before it turns into a debilitating illness. This can be achieved by identifying risk patients, especially smokers, and using spirometry tools and protocol questionnaires for disease detection.

The MESI mTABLET SPIRO+ is a portable digital spirometry tool with self-calibration, multiple measurement modes and numerous parameter calculation options. It can easily be combined with the Protocol app to guide you through various COPD questionnaires in the examination – saving time and assuring an equal level of care for all risk patients.