1. Diagnosi della BPCO 1

2. GOL D lobal Initiative for Chronic bstructive ung isease
© Global Initiative for Chronic Obstructive Lung Disease 2

3. Global Strategy for Diagnosis, Management and Prevention of COPD Diagnosi e valutazione del paziente con BPCO
A clinical diagnosis of 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.
Spirometry is required to make the diagnosis; the presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD. 3

4. Indoor/outdoor pollution
Diagnosi della BPCO sulla base di sintomi, fattori di rischio e spirometria
SYMPTOMS
Cough
Sputum production
Shortness of breath
RISK FACTORS
Tobacco
Occupational hazards
Indoor/outdoor pollution +
Spirometry
Speaker notes
Spirometry is recommended at the time of diagnosis to assess the presence and severity of airflow limitation.1,2
A diagnosis of COPD should be considered in any patient who has cough, sputum production, or dyspnoea and/or a history of exposure to risk factors.1
References
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD
Celli BR, MacNee W, ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004;23:932–946.
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) Available from 4

5. Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO
Determine the severity of the disease, its impact on the patient’s health status and the risk of future events (for example exacerbations) to guide therapy. Consider the following aspects of the disease separately: 
current level of patient’s symptoms
severity of the spirometric abnormality
frequency of exacerbations
presence of comorbidities. 5

6. Assess degree of airflow limitation using spirometry
Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO
Assess symptoms
Assess degree of airflow limitation using spirometry
Assess risk of exacerbations
Assess comorbidities 6

7. Use the COPD Assessment Test (CAT) or mMRC Breathlessness scale
Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO
Assess symptoms
Assess degree of airflow limitation using spirometry
Assess risk of exacerbations
Assess comorbidities
Use the COPD Assessment Test (CAT) or
mMRC Breathlessness scale 7

8. Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO
Assess symptoms
Assess degree of airflow limitation using spirometry
Assess risk of exacerbations
Assess comorbidities
Use spirometry for grading severity according to spirometry, using four grades split at 80%, 50% and 30% of predicted value 8

9. In patients with FEV1/FVC < 0.70:
Global Strategy for Diagnosis, Management and Prevention of COPD Classificazione della gravità della BPCO in base alla limitazione al flusso aereo*
In patients with FEV1/FVC < 0.70:
GOLD 1: Mild FEV1 > 80% predicted
GOLD 2: Moderate 50% < FEV1 < 80% predicted
GOLD 3: Severe 30% < FEV1 < 50% predicted
GOLD 4: Very Severe FEV1 < 30% predicted
*Based on Post-Bronchodilator FEV1 9

10. Use history of exacerbations and spirometry.
Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO
Assess symptoms
Assess degree of airflow limitation using spirometry
Assess risk of exacerbations
Assess comorbidities
Use history of exacerbations and spirometry.
Two exacerbations or more within the last year
or an FEV1 < 50 % of predicted value are
indicators of high risk 10

11. Global Strategy for Diagnosis, Management and Prevention of COPD Determinare il rischio di riacutizzazioni
To assess risk of exacerbations use history of exacerbations and spirometry:
Two or more exacerbations within the last year or an FEV1 < 50 % of predicted value are indicators of high risk. 11

12. Assess degree of airflow limitation using spirometry
Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO
Assess symptoms
Assess degree of airflow limitation using spirometry
Assess risk of exacerbations
Combine these assessments for the purpose of improving management of COPD 12

13. COPD patients are at increased risk for:
Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione delle comorbilità
COPD patients are at increased risk for:
Cardiovascular diseases
Osteoporosis
Respiratory infections
Anxiety and Depression
Diabetes
Lung cancer
These comorbid conditions may influence mortality and hospitalizations and should be looked for routinely, and treated appropriately. 13