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Chronic obstructive pulmonary disease - Management
How should I assess the severity of COPD?
- Assess the degree of airflow obstruction according to the reduction in post-bronchodilator forced expiratory volume in 1 second (FEV1) on spirometry and classify as follows:
- Stage 1 — mild: FEV1 80% of predicted value or higher (symptoms must be present).
- Stage 2 — moderate: FEV1 50–79% of predicted value.
- Stage 3 — severe: FEV1 30–49% of predicted value.
- Stage 4 — very severe: FEV1 less than 30% of predicted value.
- Assess the degree of breathlessness according to the Medical Research Council dyspnoea scale.
- Calculate the person's body mass index (weight in kg/height in m2). See Nutrition.
- Assess for the presence of cor pulmonale — features include:
- Peripheral oedema.
- Raised jugular venous pressure.
- Systolic parasternal heave.
- A loud pulmonary second heart sound (over the second left intercostal space).
- Widening of the descending pulmonary artery on chest X-ray.
- Right ventricular hypertrophy on electrocardiography.
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