COPD — Diagnosis & Management

Spirometry-confirmed; GOLD ABE guides therapy

Field: RespiratoryCode: RS-02Updated: June 2026Reference: GOLD 2025 / COPD-X Plan

Diagnose by post-bronchodilator spirometry (FEV1/FVC < 0.7) — then classify by symptom burden and exacerbation history (GOLD ABE) to guide initial therapy. Smoking cessation remains the single most effective intervention available — see the Smoking Cessation sheet (EN-09).

Diagnostic pathway

From clinical suspicion to escalation.

Suspect: smoking history, dyspnoea, cough, sputum, age > 40.

Confirm: post-BD spirometry — FEV1/FVC < 0.7.

Assess: CAT/mMRC + exacerbation history → Group A/B/E.

Initiate: smoking cessation + inhaler per group + vaccines.

Optimise/refer: pulmonary rehab, LTOT if indicated, specialist if severe.

GOLD ABE classification

Symptom burden + exacerbation risk → initial bronchodilator choice.

Low symptoms (CAT<10, mMRC 0–1), ≤1 exacerbation/yr, no hospitalisation — single bronchodilator (LAMA or LABA).

Higher symptoms (CAT≥10 or mMRC≥2), ≤1 exacerbation/yr, no hospitalisation — LABA+LAMA combination.

≥2 exacerbations/yr or ≥1 hospitalisation — LABA+LAMA; consider adding ICS if blood eosinophils ≥300 cells/µL.

Inhaler choice & FEV1 staging — Device class selection (LAMA/LABA/ICS combinations, brands) — see the RS-03 Inhaler Decision Guide. GOLD 1–4 FEV1 staging informs prognosis but not initial Rx, which follows ABE group. Reversibility testing is not routinely needed once FEV1/FVC < 0.7 is confirmed.

Acute exacerbation

Anthonisen cardinal symptoms: increased dyspnoea, increased sputum volume, increased sputum purulence. Purulent sputum is the key trigger for antibiotics; the more cardinal symptoms present, the stronger the case. Give SABA+SAMA (spacer/nebuliser) and a short oral corticosteroid course; confirm current antibiotic choice and duration at eTG/COPD-X, as stewardship guidance evolves.

Non-pharmacological care

Smoking cessation — slows FEV1 decline; the single most important intervention.
Pulmonary rehabilitation — a structured ~6–8 week program (Lung Foundation Australia); refer all symptomatic patients.
Vaccination — annual influenza, pneumococcal, COVID-19, and RSV in eligible groups.
LTOT — consider if PaO2 ≤55 mmHg or SpO2 ≤88% on room air at rest in a stable state; refer respiratory.

Annual review & care plans

Spirometry annually to track FEV1 decline. Check inhaler technique at every visit and maintain a written action plan. Check eosinophils before adding ICS. A chronic-condition GP management plan applies (the GPCCMP replaced the old GPMP/TCA items, incl. former item 721, from 1 Jul 2025) — confirm the current item number and rebate at mbsonline.gov.au.

Safety

Confirm with post-BD spirometry before labelling COPD — asthma overlap is common.
Continue maintenance inhalers through an exacerbation; don't stop them.
Poor inhaler technique can mimic treatment failure — check at every visit.
Don't start unsupervised home oxygen outside LTOT criteria — risk in CO2 retainers.

Red flags / refer

Diagnostic uncertainty, age < 40, or suspected alpha-1 antitrypsin deficiency.
≥2 exacerbations in 12 months despite optimised therapy.
Persistent symptoms with FEV1 < 50% predicted despite optimised therapy.
Consideration of LTOT, or surgical/transplant assessment.

RS-02 v1.0 · Reviewed Jun 2026 · Review Jun 2027

For health-professional use. Diagnosis & classification adapted from GOLD 2025 and the COPD-X Plan (living document) — confirm at copdx.org.au. Inhaler class choice — see RS-03. Confirm PBS listings at pbs.gov.au and current GP care-plan item at mbsonline.gov.au.