The most recent NICE COPD guideline, NG115 – Chronic obstructive pulmonary disease in over 16s: diagnosis and management – specifically acknowledges the need for a secure diagnosis to enable appropriate subsequent management. Diagnosis should be suspected using signs and symptoms and supported by spirometry performed by appropriately trained healthcare workers who have up-to-date skills and are competent in interpreting results. See below for more.

Diagnosis should include:

• Noting exacerbation history
• Excluding conditions such as asthma and cancer
• Consideration of alternative diagnoses such as alpha 1 antitrypsin disease or early pulmonary fibrosis, which may be misdiagnosed as COPD.

The guideline states: “Suspect a diagnosis of COPD in people over 35 who have a risk factor (generally smoking or a history of smoking) and who present with one or more of the following symptoms: exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis and wheeze.”