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A diagnosis of COPD relies on clinical judgement based on a combination of history, physical examination and confirmation of the presence of airflow obstruction using spirometry.
NICE clinical guidelines provide the following definition of COPD:
The NICE guidelines require post bronchodilator spirometry for diagnosis and gradation of severity of airways obstruction. Failure to use post bronchodilator readings has been shown to overestimate the prevalence of COPD by 25 per cent45. Spirometry should be performed after the administration of an adequate dose of an inhaled bronchodilator (e.g. 400mcg salbutamol).
Prior to performing post-bronchodilator spirometry, patients do not need to stop any therapy, such as long acting bronchodilators or inhaled steroids.
Routine reversibility testing is not recommended. However, where doubt exists as to whether the diagnosis is asthma or COPD, reversibility testing may add additional information to post bronchodilator readings alone and peak flow charts are useful. It is acknowledged that COPD and asthma can co-exist and that many patients with asthma who smoke will eventually develop irreversible airways obstruction. Where asthma is present, these patients should be managed as asthma patients as well as COPD patients. This will be evidenced by a greater than 400mls response to a reversibility test and a post bronchodilator FEV1 of less than 80 per cent of predicted normal as well as an appropriate medical history.
Patients with reversible airways obstruction should be included on the asthma register. Patients with coexisting asthma and COPD should be included on the register for both conditions.
The guideline on COPD recommends that all health professionals involved in the care of patients with COPD should have access to spirometry and be competent in the interpretation of the results. Quality statement 1 (diagnosis) in the NICE quality standard for COPD in adults states that patients with COPD have the diagnosis confirmed by post bronchodilator spirometry carried out on calibrated equipment by healthcare professionals competent in its performance and interpretation.
NICE clinical guideline 101 (2010). Chronic obstructive pulmonary disease.
NICE quality standard on COPD (2011). Chronic obstructive pulmonary disease
(COPD) quality standard.
From April 2011 the diagnostic codes for this indicator have been updated to include new codes for post bronchodilator spirometry. The previous codes for reversibility testing will no longer be acceptable for QOF purposes.
See indicator wording for requirement criteria.
Prepared By Jean Keenan