title: The diagnosis of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Estimates of the prevalence of chronic obstructive pulmonary disease (COPD) in Germany range from 1.9% to 13.2%, depending on the population studied and the investigative methods used. About 30% of all patients already have severe airway obstruction by the time the condition is diagnosed.
  
  
  METHODS
  Review of pertinent literature retrieved by a selective search, including current guidelines and textbooks.
  
  
  RESULTS
  Smoking is the main risk factor for COPD. The diagnosis is based on characteristic symptoms that patients at risk should be actively asked about-cough, dyspnea, diminished physical reserve, and frequent airway infections-together with abnormal pulmonary function tests. Spirometry usually suffices to document impaired air flow. The clinical evaluation and the treatment strategy are based on the severity of airway obstruction and dyspnea, and the frequency of exacerbations. According to a European study, dyspnea is present in 73% of persons with severe COPD, expectoration in 64%, cough in 59%, and wheezing in 42%. Asthma, congestive heart failure, and interstitial lung disease are the main differential diagnoses.
  
  
  CONCLUSIONS
  COPD may begin with symptoms that are only mild at first even in a longstanding smoker. The available diagnostic techniques need better prospective validation with respect to relevant endpoints, including mortality, symptom progression, quality of life, and frequency of exacerbations.
authors.affiliation: Lower Saxony State Association of Statutory Health Insurance Physicians, Office Oldenburg, Vivantes Klinikum Berlin-Neukölln, Department of Internal Medicine, Pneumology, and Infectious Diseases.
authors.forename: Rainer
authors.initials: R
authors.lastname: Burkhardt
authors.forename: Wulf
authors.initials: W
authors.lastname: Pankow
mesh_terms: D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D006801:Humans; D010808:Physical Examination / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D012129:Respiratory Function Tests / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D012907:Smoking / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000379:methods*