J Korean Med Assoc Search

CLOSE


J Korean Med Assoc > Volume 61(9); 2018 > Article
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.

References

1. Pauwels RA, Rabe KF. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet 2004;364:613-620.
crossref pmid
2. Yoo KH, Kim YS, Sheen SS, Park JH, Hwang YI, Kim SH, Yoon HI, Lim SC, Park JY, Park SJ, Seo KH, Kim KU, Oh YM, Lee NY, Kim JS, Oh KW, Kim YT, Park IW, Lee SD, Kim SK, Kim YK, Han SK. Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008. Respirology 2011;16:659-665.
crossref pmid
3. Yoon HK, Park YB, Rhee CK, Lee JH, Oh YM. Committee of the Korean COPD Guideline 2014. Summary of the chronic obstructive pulmonary disease clinical practice guideline revised in 2014 by the Korean Academy of Tuberculosis and Respiratory Disease. Tuberc Respir Dis (Seoul) 2017;80:230-240.
crossref pmid pmc pdf
4. Korea Academy of Tuberculosis and Respiratory Diseases. COPD clinical practice guidelines revised in 2018 [Internet] Seoul: Korean Academy of Tuberculosis and Respiratory Disease. 2018;cited 2018 Sep 1. Available from: http://www.lungkorea.org/bbs/?code=guide

5. Woodruff PG, Barr RG, Bleecker E, Christenson SA, Couper D, Curtis JL, Gouskova NA, Hansel NN, Hoffman EA, Kanner RE, Kleerup E, Lazarus SC, Martinez FJ, Paine R 3rd, Rennard S, Tashkin DP, Han MK. SPIROMICS Research Group. Clinical significance of symptoms in smokers with preserved pulmonary function. N Engl J Med 2016;374:1811-1821.
crossref pmid pmc
6. Eisner MD, Blanc PD, Yelin EH, Katz PP, Sanchez G, Iribarren C, Omachi TA. Influence of anxiety on health outcomes in COPD. Thorax 2010;65:229-234.
crossref pmid
7. Wagner PD. Possible mechanisms underlying the development of cachexia in COPD. Eur Respir J 2008;31:492-501.
crossref pmid
8. Schunemann HJ, Dorn J, Grant BJ, Winkelstein W Jr, Trevisan M. Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study. Chest 2000;118:656-664.
crossref pmid
9. Chung KS, Jung JY, Park MS, Kim YS, Kim SK, Chang J, Song JH. Cut-off value of FEV1/FEV6 as a surrogate for FEV1/FVC for detecting airway obstruction in a Korean population. Int J Chron Obstruct Pulmon Dis 2016;11:1957-1963.
pmid pmc
10. Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 2002;121:1434-1440.
crossref pmid
11. Korea Academy of Tuberculosis and Respiratory Diseases. Resource center: mMRC [Internet] Seoul: Korean Academy of Tuberculosis and Respiratory Disease. 2018;cited 2018 Sep 8. Available from: Korean http://www.lungkorea.org/calculator/?code=mmrc

12. Lee S, Lee JS, Song JW, Choi CM, Shim TS, Kim TB, Cho YS, Moon HB, Lee SD, Oh YM. Validation of the Korean version of chronic obstructive pulmonary disease assessment test (CAT) and dyspnea-12 questionnaire. Tuberc Respir Dis 2010;69:171-176.
crossref
13. Lee SD, Huang MS, Kang J, Lin CH, Park MJ, Oh YM, Kwon N, Jones PW, Sajkov D. Investigators of the Predictive Ability of CAT in Acute Exacerbations of COPD (PACE) Study. The COPD assessment test (CAT) assists prediction of COPD exacerbations in high-risk patients. Respir Med 2014;108:600-608.
crossref pmid
14. Korea Academy of Tuberculosis and Respiratory Diseases. Resource center: CAT [Internet] Seoul: Korean Academy of Tuberculosis and Respiratory Disease. 2018;cited 2018 Sep 8. Available from: http://www.lungkorea.org/calculator/?code=cat

15. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation: the St. George's respiratory questionnaire. Am Rev Respir Dis 1992;145:1321-1327.
crossref pmid
16. Burge S, Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J Suppl 2003;41:46s-53s.
crossref pmid
17. Hurst JR, Vestbo J, Anzueto A, Locantore N, Mullerova H, Tal-Singer R, Miller B, Lomas DA, Agusti A, Macnee W, Calverley P, Rennard S, Wouters EF, Wedzicha JA. Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010;363:1128-1138.
crossref pmid
18. Kim MH, Lee K, Kim KU, Park HK, Jeon DS, Kim YS, Lee MK, Park SK. Risk factors associated with frequent hospital readmissions for exacerbation of COPD. Tuberc Respir Dis 2010;69:243-249.
crossref
19. Joo H, Park J, Lee SD, Oh YM. Comorbidities of chronic obstructive pulmonary disease in Koreans: a population-based study. J Korean Med Sci 2012;27:901-906.
crossref pmid pmc pdf
20. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008;32:962-969.
crossref pmid

Appendices

Appendix 1

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

jkma-61-539-a001-l.jpg

Appendix 2

COPD Assessment Tool (CAT) (in Korean)

jkma-61-539-a002-l.jpg
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).

jkma-61-539-g001-l.jpg
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.

jkma-61-539-g002-l.jpg
Table 1

Key indicators for considering the diagnosis of COPD

jkma-61-539-i001-l.jpg

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

jkma-61-539-i002-l.jpg
Table 3

COPD Assessment Test

jkma-61-539-i003-l.jpg

COPD, chronic obstructive pulmonary disease.



ABOUT
ARTICLE CATEGORY

Browse all articles >

ARCHIVES
FOR CONTRIBUTORS
Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next