Breathlessness, cough and a smoking history make COPD likely, but the diagnosis needs spirometry. A post-bronchodilator FEV1/FVC ratio below 0.70 confirms persistent airflow obstruction in the right clinical setting. Without it, asthma, heart failure, bronchiectasis, tuberculosis sequelae and obesity can all be mislabelled as COPD.
In India, remember that biomass smoke exposure and previous tuberculosis cause airflow obstruction in people who have never smoked. Ask about cooking fuel and prior tuberculosis. Record the ratio and the post-bronchodilator FEV1 so the stage can be reassessed.
- Confirm obstruction with post-bronchodilator FEV1/FVC below 0.70.
- Ask about biomass smoke exposure and previous tuberculosis in never-smokers.
- Consider other causes of breathlessness when spirometry is normal.
- Record the ratio and FEV1 so they can be tracked over time.
Why it matters
A diagnosis made without spirometry commits the patient to inhalers that may not be needed.
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