How can I effectively assess the severity of COPD in a patient presenting with respiratory symptoms?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

To effectively assess the severity of COPD in a patient presenting with respiratory symptoms, consider the following factors:

  • Measure the FEV1 to assess airflow obstruction, categorising severity according to the reduction in FEV1 as shown in table 4, with mild being FEV1 ≥80% predicted, moderate 50–79%, severe 30–49%, and very severe below 30% .
  • Evaluate symptom burden using tools such as the COPD Assessment Test (CAT) score, where a score >10 indicates higher symptom severity .
  • Assess exacerbation history by noting the frequency and severity of exacerbations and hospital admissions, which are linked to prognosis and treatment decisions ,.
  • Use the MRC dyspnoea scale to grade breathlessness according to activity level, which correlates with disease severity .
  • Consider additional prognostic factors such as smoking status, presence of hypoxia or cor pulmonale, BMI, exercise capacity, and multimorbidity, as these influence prognosis and management .

In summary, a comprehensive assessment includes spirometry (FEV1), symptom scoring (CAT, MRC), exacerbation history, and evaluation of other prognostic factors ,.

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