Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is not a single disease, but a group of medical conditions characterized by chronic reduction of maximal expiratory flow most often caused by:

• Chronic bronchitis.
• Emphysema.

Most drivers with COPD have a combination of chronic bronchitis and emphysema. COPD has an insidious onset. The driver may have substantial reduction in lung function prior to developing dyspnea on exertion. The cardinal symptoms are:

• Chronic cough.
• Sputum production.
• Dyspnea on exertion.

As the disease progresses, these symptoms can become incapacitating. In the majority of cases, cigarette smoking is a primary etiologic factor.

Waiting period

No recommended time frame

You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.

Decision

Maximum certification — 2 years

Recommend to certify if:

As the medical examiner, you believe that the nature and severity of the medical condition of the driver is stable and does not endanger the health and safety of the driver and the public.

Recommend not to certify if:

The driver has:

• Hypoxemia at rest.
• Chronic respiratory failure.
• History of continuing cough with cough syncope.

Monitoring/Testing

Obvious difficulty breathing in a resting position is an indicator for additional pulmonary function tests. If the forced expiratory volume in the first second of expiration (FEV₁) is less than 65% of that predicted, arterial blood gas measurements should be evaluated.

NOTE: Smokers have a high incidence of COPD, yet individuals may have a significant reduction in lung function without symptoms. Spirometry should be performed in all smokers over the age of 35 years.

Follow-up

The driver should have follow-up dependent upon the clinical course of the condition and recommendation of the treating healthcare provider.

The complete text of the medical conference reports can be accessed from FMCSA Medical Reports.