Chronic respiratory disease

March 2010

FocusChronic respiratory disease


Diagnosis, management and the role of the GP

Volume 39, No.3, March 2010 Pages 100-103

Julia Walters


Chronic obstructive pulmonary disease (COPD) is a common condition characterised by breathlessness, cough and sputum production. However these are nonspecific, common symptoms which may be misattributed; resulting in a possible underdiagnosis of COPD.


To outline the current views on COPD diagnosis and management with a focus on the role of the general practitioner.


An initial important step is to consider and confirm the diagnosis of COPD. Management of COPD focuses on optimising function, preventing deterioration, developing support networks and self management, and managing exacerbations.

Health professionals in primary care are generally the first point of contact for people with symptoms of chronic respiratory conditions.1 Although the main symptoms of chronic obstructive pulmonary disease (COPD) are breathlessness, cough and sputum production,2 these are nonspecific and of gradual onset outside exacerbations, and frequently reported by individuals with normal spirometry.3 Symptoms may be attributed by patients to aging or lack of fitness; doctors may attribute them to acute respiratory infections and fail to seek an underlying diagnosis;4 and negative attitudes to treatment of COPD may deter doctors from making a diagnosis.5 These factors contribute to considerable underdiagnosis of COPD, delayed diagnosis with disease progression, and missed opportunities for preventing further deterioration.2 However, there is good evidence that a range of pharmacological and nonpharmacological interventions are effective in improving symptoms, improving quality of life, and reducing the frequency and impact of exacerbations. Summaries of regularly updated recommendations accompanied by grading of the supporting evidence now exist to guide diagnosis and management of COPD.6–8

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