C2. Diagnosis

C2.1 History

Consider COPD in all smokers and ex-smokers over the age of 35 years (Fletcher and Peto, 1977) [evidence level II]

The main symptoms of COPD are breathlessness, cough and sputum production. Patients often attribute breath­lessness to ageing or lack of fitness. A persistent cough, typically worse in the mornings with mucoid sputum, is common in smokers. Other symptoms such as chest tight­ness, wheezing and airway irritability are common. (Thompson et al., 1992) People with chronic cough and sputum are at increased risk of exacerbation (Burgel et al., 2009) [evidence level III-2]. Acute exacerbations, usually infective, occur from time to time and may lead to a sharp deterioration in coping ability. Fatigue, poor appetite and weight loss are more common in advanced disease.

The functional limitation from breathlessness due to COPD can be quantified easily in clinical practice (Bestall et al., 1999) (see Box 4).

The COPD assessment test (CAT) (Jones et al., 2009)  may provide useful information when taking a history from patients. The CAT quantifies the impact COPD has on a patient’s wellbeing and daily life, with the aim of facilitating communication between healthcare professionals and patients. The test is comprised of eight questions pertaining to cough, sputum, chest tightness, exercise tolerance, ability to perform activities of daily living, confidence in leaving the home, sleep and energy levels. The CAT is freely available in many languages (see http://www.catestonline.org/english/index.htm). It is easy and quick to complete, and score.