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Diagnostic Criteria in Asthma & COPD

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Diagnostic Criteria in Asthma & COPD

Respiratory symptoms of cough, wheeze and shortness of breath are common to many respiratory conditions and can pose a challenge to health care professionals when making a diagnosis. In practice, asthma and Chronic Obstructive Pulmonary Disease (COPD) are the two most commonly confused respiratory conditions. There is no single diagnostic test that can conclusively detect either condition. Detailed history taking, which looks at the presence of predisposing or risk factors for different diseases, and the type, severity and pattern of symptoms is essential in establishing the most likely diagnosis. Appropriate use of objective tests such as spirometry or peak flow to measure lung function may then be used to help confirm or refute the potential diagnosis.

British and international guidelines for asthma and COPD reinforce the importance of clinical judgement based on a detailed history and supported by objective measurements of lung function in making a diagnosis and excluding other pathologies, although draft guidance from NICE puts more emphasis on obective tests than on the history, and recommends spirometry as the first line investigation.

This resource, which is based on a typical case scenario, is offered at an intermediate level and includes five assessment questions to support your continuing professional development. Complete the resource to obtain a certificate for one hour of continuing professional development to include in your annual portfolio.

Aims and Objectives

On completion of this resource you should have an understanding of:

  • The importance of history taking in the differential diagnosis of asthma and COPD
  • The key features in a history that can help distinguish between asthma and COPD
  • ‘Red flag’ symptoms that can indicate other serious pathologies
  • The role of lung function testing in the diagnosis of respiratory disease
  • The role of clinical investigations in the diagnosis of asthma and COPD

Reading List

British Thoracic Society/Scottish IntercollegiateGuidelines Network British Guideline on the Management of Asthma, 2014 http://www.sign.ac.uk/pdf/SIGN141.pdf

NICE CG101. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care: Update guideline, 2010. www.nice.org.uk/cg101 

Department of Health. An outcomes strategy for Chronic Obstructive Pulmonary Disease (COPD) and Asthma in England, 2011 www.gov.uk/government/publications/an-outcomes-strategy-for-people-with-chronic-obstructive-pulmonary-disease-copd-and-asthma-in-england

NICE. National Clinical Guideline Centre. Asthma: diagnosis and monitoring of asthma in adults, children and young people. Clinical guideline (Draft), January 2015 https://www.nice.org.uk/guidance/gid-cgwave0640/resources/asthma-diagnosis-and-monitoring-draft-guideline2

Primary Care Commissioning. A guide to quality assured diagnostic spirometry, 2013. http://www.pcc-cic.org.uk/article/guide-quality-assured-diagnostic-spirometry

Further education and training

Differential diagnosis for asthma and COPD forms part of all asthma and COPD diploma and degree level courses in addition to one day workshops provided by Education for Health. For further information please see:

Asthma eLearning Degree Module

COPD eLearning Degree Module 

Asthma eLearning Diploma Module 

Asthma eLearning Diploma Module (Stirling)

Asthma eLearning Diploma Module (London)

COPD eLearning Diploma Module

COPD eLearning Diploma Module (Stirling)

Essentials of Asthma Workshop

Essentials of COPD Workshop

Paediatric Asthma Workshop

Spirometry workshop

Date of preparation: February 2014

Review date: February 2015