Please complete the Improving Patient Outcomes for COPD course and then comment on this discussion topic to share your experiences, takeaways, and outstanding questions. 

Consider responding to one of the questions below:

  1. What has been your experience with screening, treating and managing chronic obstructive pulmonary disease (COPD) in a primary care setting? Share both positive and negative experiences. 
  2. What questions do you still have about treating and monitoring COPD in primary care?
  3. What do you want to know from other clinicians who screen for and treat COPD?


Have you wondered what to do with patients who appear to have COPD because of smoking history and symptoms but do not meet the criteria of airflow obstruction by spirometry? This is may be of particular concern if they have emphysema or airway wall thickening on a CT scan of the chest.

Though the definitive diagnosis of COPD requires demonstration of airflow obstruction by spirometry, analysis of data from the COPD Gene study suggests that we should consider categories of ‘probable’ and ‘possible’ COPD. All these patients have adequate tobacco smoke exposure (>10 pack-yrs) to be at risk of COPD. The ‘probable’ patients have symptoms and radiological changes, while the ‘possible’ ones have only one of those diagnostic features.

Though this concept has yet not been adopted by international recommendations, I have started to apply it in my ‘borderline’ COPD patients or in those where I had diagnostic confusion between asthma and COPD, in order to guide my therapeutic approach. I may give these patients a trial of a long-acting bronchodilator to see if they note improvement in symptoms. I am interested in hearing about other’s experience with similar patients.

Sanjay Sethi replied on