Course 04: Respiratory Medicine and Infectious Disease
Lesson 4 of 14. Explore the diagnostic and management frameworks, work through the case, and finish the linked 10-question practice set. Urgent presentations require an emergency-care pathway and review of local professional scope.
Confirmation and differential
- Consider COPD with persistent dyspnea, cough, sputum and tobacco, biomass or occupational exposures; confirm post-bronchodilator airflow obstruction by spirometry.
- GOLD uses post-bronchodilator FEV1/FVC below 0.70 as its diagnostic threshold; age-related misclassification and lower limit of normal warrant clinical judgment.
- Investigate alternatives or overlap: asthma, heart failure, bronchiectasis, interstitial disease, obesity, anemia and vocal cord disorders.
Symptom and risk characterization
- Assess breathlessness, activity tolerance, exacerbation count and severity, hospitalization, inhaler access and comorbidity; spirometry grade alone does not define total risk.
- Smoking cessation is a major disease-modifying intervention; discuss counselling, approved cessation aids, vaccinations and occupational exposure controls.
- Alpha-1 antitrypsin deficiency evaluation should be considered in COPD, especially early onset, family history or emphysema without typical exposure.
Maintenance plan
- Choose bronchodilator treatment aligned to symptoms/exacerbation risk; LAMA/LABA combinations are important for many symptomatic patients.
- Inhaled corticosteroid use in COPD is selective, guided by exacerbation patterns, eosinophil count, possible concurrent asthma and pneumonia risk; avoid universal ICS use.
- Check technique/adherence, pulmonary rehabilitation and exercise tolerance, nutrition and mood before reflexively escalating inhalers.
Follow-up and complications
- Reassess inhaler technique, symptoms, new exacerbations, oxygenation, weight, physical function, depression, cardiac disease and sleep disorder symptoms.
- Long-term oxygen should follow established severe chronic resting hypoxemia criteria, not be prescribed solely for exertional dyspnea with normal oxygenation.
- Advance care planning and supportive approaches should be offered respectfully in advanced disease without replacing evidence-based treatment.
Applied clinical case
A 65-year-old former smoker is labelled COPD, has dyspnea and is taking triple therapy, but no previous spirometry can be found.
Show model clinical reasoning and disposition
Arrange quality post-bronchodilator spirometry once stable and reassess diagnosis, symptoms, inhaler benefits and harms; do not treat an unconfirmed label as definitive.
Clinical self-check
- Which spirometric finding supports COPD?
- When may ICS be inappropriate?
- What is the value of rehabilitation?
Current guidance and further learning
- GOLD 2026: COPD report and pocket guide (external)
- Choosing Wisely Canada: Respiratory medicine (external)
- Canadian Thoracic Society guideline library (external)