Box 4. An outline of screening and diagnosis protocols for asthma and COPD (extracted from case management desk-guide)
ScreeningAsthma is indicated, if:
  • younger patient (though can be an older adult)

  • patient and/or family has history of asthma, allergic rhinitis (hay fever), or eczema

  • patient complains of:

    • recurrent episodes of dry cough and/or difficulty breathing, more so at night or in the morning

    • worsening with exercise, cold, dust, seasonal allergens, or drugs

COPD is indicated, if:
  • middle-aged or older adult who smokes or used to smoke

  • patient has a history of recurrent chest infection

  • patient complains of:

    • progressive persistent shortness of breath (rather than episodic)

    • cough (productive and persistent)

    • exercise worsening the symptoms.

Assess for asthma or COPD diagnosis, if one or more of the above indications.
DiagnosisDiagnose asthma, if patient has history of ≥1 asthma indications, and during an exacerbation has:
  • wheeze (widespread and more on expiration)

  • on investigation (may be normal):

  • PEFR during an exacerbation <80% which improves with bronchodilator

  • other supporting/ indicative investigations:

  • blood CP (eosinophil >5%, though also in bronchitis and COPD)

  • chest X-rays (not usually indicated; may be normal, may be hyperinflation)

Diagnose COPD, if patient has history of ≥1 COPD indications, and has:
  • wheeze – widespread and more on expiration

  • on investigation:

  • PEFR during an exacerbation <80%, with minor or no change with bronchodilator

  • other supporting/ indicative investigations:

  • blood CP (to check for anemia and polycythemia, if required)

  • chest X-rays (vertical heart, hyperinflated lungs, low-set diaphragm)

  • COPD = chronic obstructive pulmonary disease. Blood CP = blood complete picture. PEFR = peak expiratory flow rate.