COPD — Frequently asked questions (FAQ)
1) What does this algorithm cover?
The algorithm guides the diagnostic assessment, classification and treatment of chronic obstructive pulmonary disease (COPD). It includes clinical and functional diagnostic criteria, GOLD classification and the ABE grouping system, assessment of exacerbation risk, and pharmacological and non-pharmacological treatment strategies.
2) When should COPD be suspected?
COPD should be suspected in the presence of progressive dyspnoea, chronic cough, persistent sputum production, recurrent wheezing or frequent respiratory infections, particularly in individuals with a history of smoking, occupational exposure to dust or gases, or other environmental risk factors.
3) How is the diagnosis confirmed?
Diagnosis requires demonstration of persistent airflow obstruction by post-bronchodilator spirometry. The classic functional criterion is a post-bronchodilator FEV1/FVC ratio <0.70. Spirometry is essential for diagnostic confirmation.
4) What is the difference between the GOLD and ABE classifications?
The GOLD 1–4 classification assesses the severity of airflow limitation based on FEV1. The ABE classification integrates symptom burden and exacerbation risk and is currently used to guide initial treatment.
5) What does group A mean?
Group A includes patients with few symptoms and a low risk of exacerbations. Initial management usually consists of long-acting bronchodilator monotherapy with a LAMA or LABA, together with smoking cessation, vaccination and encouragement of physical activity.
6) When should dual bronchodilation with LAMA+LABA be used?
The LAMA+LABA combination is recommended mainly for more symptomatic patients or those with relevant functional limitation, particularly in groups B and E. Whenever possible, treatment with a single inhaler is currently preferred.
7) When are inhaled corticosteroids indicated?
An inhaled corticosteroid (ICS) should be considered mainly in patients with frequent exacerbations, peripheral blood eosinophilia or coexisting asthma. Triple therapy with ICS+LABA+LAMA is generally reserved for patients at higher risk of exacerbations. ICS monotherapy is not recommended in COPD.
8) What are COPD exacerbations?
Exacerbations are acute episodes of worsening respiratory symptoms beyond the usual day-to-day variability of the disease and may require corticosteroids, antibiotics, hospital assessment or admission. Exacerbation frequency directly influences ABE classification and treatment strategy.
9) Which non-pharmacological measures are essential?
Smoking cessation is the most important intervention. Appropriate vaccination, including influenza, pneumococcal and COVID-19 vaccines and others according to the clinical context, regular physical activity, education on inhaler technique and pulmonary rehabilitation in selected cases should also be promoted.
10) When should pulmonary rehabilitation be considered?
Pulmonary rehabilitation should be considered in patients with relevant symptoms, marked functional limitation or following exacerbations. It is associated with improved exercise tolerance and quality of life and fewer hospital admissions.
11) Does bronchodilator reversibility exclude COPD?
No. Some patients with COPD may show partial reversibility after bronchodilator administration. Diagnosis should integrate the clinical history, risk factors and persistence of airflow obstruction. The presence of reversibility does not exclude COPD and does not necessarily imply a diagnosis of asthma.
12) When should specialist referral be considered?
Referral should be considered in cases of diagnostic uncertainty, frequent exacerbations, respiratory failure, a need for oxygen therapy, suspected coexisting asthma and COPD, rapid disease progression or a need for advanced treatment, including possible biological therapy.
