Journal List > J Korean Med Assoc > v.61(9) > 1101040

Kim and Oh: The diagnosis of chronic obstructive pulmonary disease according to current guidelines

Abstract

Chronic obstructive pulmonary disease (COPD) should be considered in any patient who has dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease, such as cigarette smoking, biomass exposure, and occupational dust. Spirometry is required to make the diagnosis, and a post-bronchodilator forced expiratory volume in one second/forced vital capacity ratio <0.7 confirms the presence of persistent airflow limitation. The goal of COPD assessment is to determine the severity of the disease, including the severity of airflow limitation, the impact of the disease on the patient's health status, the risk of future events (such as exacerbations, hospital admission, or death), and comorbidities in order to guide therapy. Concomitant chronic diseases occur frequently in COPD patients, including cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, depression, anxiety, and lung cancer. These comorbidities should be actively surveilled and treated appropriately when present, as they can independently influence mortality and hospitalization. Above all, further efforts are required to increase the diagnosis rate of COPD in Korea.

Figures and Tables

Figure 1

COPD-6. A chronic obstructive pulmonary disease screening device measuring forced expiratory volume in one second and forced expiratory volume in six seconds (courtesy of Vitalograph).

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Figure 2

Combined chronic obstructive pulmonary disease assessment (forced expiratory volume in one second [FEV1], symptom, acute exacerbation). Group (Ga): low risk, low symptom. FEV1 ≥60% of predicted value and no or one exacerbation in previous year, modified Medical Research Council (mMRC) 0 to 1 (or COPD Assessment Test [CAT] <10). Group (Na): low risk, high symptom. FEV1 ≥60% of predicted, no acute exacerbation or one in previous year, mMRC ≥2 (or CAT ≥10). Group (Da): high risk. Regardless of mMRC or CAT score, FEV1 <60% of predicted value or two acute exacerbation or one admission history related to acute exacerbation.

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Table 1

Key indicators for considering the diagnosis of COPD

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Considering COPD, and perform spirometry, if any of these indicators are present in an individual over age 40. These factors are not diagnostic themselves, but the presence of multiple key indicators increases the probability of the diagnosis of COPD. Spirometry is required to establish the diagnosis of COPD. Reproduced from Korea Academy of Tuberculosis and Respiratory Diseases. COPD clinical practice guidelines revised in 2018 [Internet]. Seoul: Korean Academy of Tuberculosis and Respiratory Disease; 2018, with permission from Korea Academy of Tuberculosis and Respiratory Diseases [4].

COPD, chronic obstructive pulmonary disease.

Table 2

Modified Medical Research Council dyspnea scale

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Table 3

COPD Assessment Test

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COPD, chronic obstructive pulmonary disease.

Appendices

Appendix 1

Modified Medical Research Council (mMRC) Dyspnea Scale (in Korean)

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Appendix 2

COPD Assessment Tool (CAT) (in Korean)

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TOOLS
ORCID iDs

Hyun Jung Kim
https://orcid.org/0000-0002-1878-1111

Yeon-Mok Oh
https://orcid.org/0000-0003-0116-4683

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