|Home | About | Journals | Submit | Contact Us | Français|
A 58 year old female smoker presents with a complaint of dyspnoea associated with chronic cough and sputum production during the winter months. Her general health is good. She recently took early retirement to spend more time with her grandchildren but found that she is too breathless to lift and carry them or to look after them safely in the park.
Chronic obstructive pulmonary disease (COPD) is largely caused by smoking and is characterised by progressive, partially reversible airflow obstruction, systemic manifestations (skeletal muscle dysfunction, depression, and secondary polycythaemia), and increasing frequency and severity of exacerbations. The main symptoms—usually insidious in onset and progressive—are shortness of breath and inability to tolerate physical activity.
History—Take a careful history to determine whether she has COPD, focusing on the main symptoms. Does she smoke or have significant exposure to secondhand smoke or occupational dust? Ask about history of exacerbations: urgent care visits, prescriptions for antibiotics or oral corticosteroids, and hospitalisation.
Comorbidity—Ask about symptoms that suggest common comorbidities such as heart and circulatory diseases, asthma, anaemia, and depression.
Referral—Look out for worrying features associated with COPD that merit referral to a specialist: diagnostic uncertainty; COPD in people under 40 or in those who have a first degree relative with history of α1 antitrypsin deficiency; severe COPD; frequent exacerbations; haemoptysis; and difficulty in controlling symptoms or a need for oxygen therapy, pulmonary rehabilitation, or surgery.
Competing interests: AM has received honoraria for speaking and consulting from Altana, AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline.
This is part of a series of occasional articles on common problems in primary care