Laboratory Tests

• Hematocrit may be elevated and may exceed 55% (polycythemia).

• Arterial blood gases (ABGs) should be obtained in patients with an FEV1 less than 40% predicted or signs or symptoms suggestive of cor pulmonale or respiratory failure. COPD patients characteristically exhibit normal or increased arterial carbon dioxide tension (PaCO2) and decreased arterial oxygen tension (PaO2).

• An AAT level should be obtained in younger patients (less than 45 years old) presenting with COPD signs and symptoms, especially if there is a strong family history of emphysema.

Table 15-1 GOLD Classification of COPD Severity3

Stage

Category

FEV^FVC (W

FiV,

Symptom i

1

Mild

!_«: thin 70

Greater thar. or equal to iOib

With of wdhout throne oougii and

iptlk*n production

II

Moderate

Less thim 70

SO^KJ pediclttl

With of WJlhout-chfone couytiand

i.piHuirs[*uduClion

III

Severe

Lew than 70

30% predicted

With of wiliiout throne cou^h apd

f ptmnri prtxJutfon

W

toys evae

Lesithan 70

Les& than 30% pedict-Gd of less

thim 50% piwJictcd plus chionK

iWpirtfOry fjilyrt*

FfV., forc^ en|iiri1i5fy votjnv in I Mfctavt FYC foffixl viral tapofity: CjiXGOkjhal Irwiijriw? fry i hronK OtetrufUje Lung Disease. iCIasiificATiflji basttl an pf^ibtfMkrhocfiUitfi FEV,.

■»■^lii Jt(n y il&r.r: ftrlfii.ll [hirl ■ ■ I pKi'JtfS Of Otyjtfi (IW.I Hi ihsn rum HE) {7.90 kPA) vvl(h cjr WillvJuE if Hfi.ll ihiil'.jl pf fWtlH1 Of til bt>n (fcaxidp |pa£HJ gfeatef 1han SO mm hg kF'artwtiiletneiUhirig arat sea level.

FfV., forc^ en|iiri1i5fy votjnv in I Mfctavt FYC foffixl viral tapofity: CjiXGOkjhal Irwiijriw? fry i hronK OtetrufUje Lung Disease. iCIasiificATiflji basttl an pf^ibtfMkrhocfiUitfi FEV,.

■»■^lii Jt(n y il&r.r: ftrlfii.ll [hirl ■ ■ I pKi'JtfS Of Otyjtfi (IW.I Hi ihsn rum HE) {7.90 kPA) vvl(h cjr WillvJuE if Hfi.ll ihiil'.jl pf fWtlH1 Of til bt>n (fcaxidp |pa£HJ gfeatef 1han SO mm hg kF'artwtiiletneiUhirig arat sea level.

It is important to distinguish COPD from asthma because treatment and prognosis differ. Differentiating factors include age of onset, smoking history, triggers, occupational history, and degree of reversibility measured by pre-and postbronchodilator spirometry. In some patients, a clear distinction between asthma and COPD is not possible. Management of these patients should be similar to that of asthma. Bronchiectasis, cystic fibrosis, obliterative bronchiolitis, congestive heart failure, and tuberculosis are other possible differential diagnoses that are usually easier to distinguish from COPD. Chest radiography or high-resolution CT along with patient presentation help rule out these other lung diseases.

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