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diagnosis on ratio of <0.7, treatment and prognosis on FEV1 % predicted

//over 35, smoker//, 
Sx - //chronic cough, regular sputum, exertional SOB//, wheeze, winter bronchitis
NOT - unproductive cough, variable Sx with night wakening - asthma
//red flags// - wt loss, effort intolerance, night waking, ankle swelling, fatigue, occupation, chest pain, haemoptysis

''Mx'' - ''//STOP SMOKING//''
annual flu jab, 10yr pneumo jab
1st SABA or SAMA prn - if still Sx - measure FEV1
2nd if FEV1 >50% LABA or LAMA  if <50% also ICS (beware inc in non-fatal pneumonia)
3rd all 3

''Improve survival''
smoking cessation
long term oxygen if fit criteria
lung volume surgery in selected pts

''Other therapy''
Oral - steroids or theophylline - if all 3 fail or intolerant
Muycolytic if helps Sx
Oxygen - FEV1<30%
Pulmonary rehab
Manage exacerbations - oral steroids, antibx, nebs, ?hospital
ICS - reduces frequency of exacerbations

''Ix''
Spirometry - post bronchodilator (shows obstructive picture - FEV1/FVC < 0.7)
FEV1 - categorises severity (I-IV, >80%, 50-80, 30-50, <30)
CXR (hyperinflation, bullae, flat hemidiaphragm, exclude ca), FBC (xclude 2ndary polycythaemia), BMI
also consider - disability, frequency of exacerbations, prognosis (SOB, exercize capacity, health status, BMI, PaO2)
peak flow - little value as underestimates obstruction