An exacerbation of Chronic Obstructive Pulmonary Disease (COPD) is a worsening of symptoms or flare-up that can have important short and long-term consequences. It is evident that patients who under-report exacerbations may have the same negative outcomes as those who do report them and there may be 2-5 times more unreported exacerbations than reported ones.
The COPD Exacerbation Recognition Tool (CERT) which was developed and is owned by GSK, was created for people with COPD to recognize the onset of an exacerbation and understand the need to report that to their healthcare providers.
The CERT provides simple visual guidance for patients to help them recognize their symptoms and seek medical attention when needed. The goal is to simplify COPD management and improve the quality of life for people who suffer from COPD.
The CERT was developed in China by experts and researchers working collaboratively with patients, with support from GSK. It was done in different regions in China, covering diverse groups of people diagnosed with COPD and had experienced exacerbations in the past.
- The development programme included participants of a wide age range, and with different levels of education and literacy, including those who were unable to read or write.
- During its development, which included patient interviews, researchers narrowed the CERT down to 5 different items that relate to the onset of an exacerbation:
- Worsening cough
- Increased sputum production
- Shortness of breath
- Limitation of motion
- The goal of the CERT is to have patients be aware that if their symptoms worsen in the way described, they may be experiencing the onset of an exacerbation.
- It gives patients a better understanding about the importance of a recent change in their symptoms.
- A key feature is the advice to seek medical attention if the patient experiences such a change.
- Tests of the specificity and sensitivity of the CERT are continuing, together with work to validate the CERT across different countries.
- Researchers believe that the CERT can help people living with COPD know when they should inform their healthcare providers about the occurrence of exacerbations, so that their treatment can be adjusted, if necessary.
- CERT is not a diagnostic tool for COPD exacerbations.
- It is simply used to help patients identify symptoms that suggest the start of an exacerbation, so they know when they need to seek medical attention.
- Patients should follow CERT guidance, but if they get worse quickly in ways that are not described in the CERT, they should be advised to still to seek medical attention.
The CERT is free for use by clinicians and patients.
The CERT is protected by copyright.
“Trademarks are owned by or licensed to the GSK group of companies © 2023 The GSK group of companies or its licensor.”
Any changes or translations of the CERT require approval by the CERT Governance Board.
GAAPP entered collaboration regarding the integration of a digitized CERT questionnaire and a German version of the CERT User Guide for Providers into the German-language patient information platform operated by Helmholtz Munich (LID): www.lungeninformationsdienst.de
The digital CERT Version is now online with LID for patients in Germany: https://www.lungeninformationsdienst.de/service/selbsttests/cert-copd-exazerbationserkennungstool
A German Tutorial made by Dr. Rainer Gloeckl, Phd CERT GB member which was released on the LID homepage and on YouTube: https://www.youtube.com/watch?v=8hpsIhzO9yI
A video podcast titled “Pneumo4Coffee2Go” about the CERT recorded for the German Respiratory Society: https://www.youtube.com/watch?v=lKodHPgRQeo&t=1658s
An educational video for clinicians created by GSK with the aim to facilitate its use in the clinic as a patient education tool: https://youtu.be/Wb0WBwrbKz0
To watch a video about the studies done in China, scan this QR code with your phone or click here
CERT Educational Postcard for Downloading
Download the CERT User Guide here:
The CERT in Japan (CERT-J) has the same goals as the original CERT. It was developed separately from the CERT, but its content is very similar [11]. The key difference is an additional item that was included following of advice of experts in Japan. The other difference is that CERT-J recommends that patients seek medical attention when three or more of the items worsen. In all other respects it should be used in the same way as the CERT.
CERT aims to be used as part of an educational program where COPD patients learn important lifestyle modifications such as: smoking cessation, diet and physical activity/exercise changes, understanding the importance of vaccines, and the need to be compliant with recommended treatments and medical care.
Two other tools should be mentioned
- The Chronic Airways Assessment Test (CAAT) measures COPD symptoms and their impact on a patient’s health and wellbeing. It can track changes in the patient’s health status over time and act as means of communication between patients and clinicians. [7] It is not designed to detect the onset of an exacerbation.
- The EXACT® and E-RS are daily diaries often used in clinical trials to track COPD symptoms and identify disease worsening events. It’s important to understand that the CERT is not a daily diary to be used in this way.
The CERT Governance Board (GB)
Our mission is to make the CERT available to a global audience of patients, families, and healthcare providers. The Global Allergy and Airways Patient Platform (GAAPP), a global umbrella nonprofit comprised of multiple patient advocacy organizations, assumed the operational lead for the GB in July 2024 with permission from GSK, the copyright owner.
The GB will focus on ensuring the CERT scientific integrity and development strategy while working with an international Scientific and Clinical panel of experts focused on validation, dissemination, translations, and implementation of the CERT in different cultures.
Members of the CERT Governance Board
- Dr. Ruth Tal-Singer, PhD, Board Operations Chair
Chief Scientific Officer
GAAPP, Vienna, Austria - Professor Paul Jones, Foundation Chair and CERT Developer
GAAPP Senior Research Physician (Consultant)
Professor Emeritus, City St George’s, University of London - Mandeep Moore GPhC, Industry Lead, GSK, UK
- Professor Toru Oga, Academic Research User Asia Pacific
Department of Respiratory Medicine, Kawasaki Medical School
Kurashiki, Okayama, Japan - Dr. Rainer Gloeckl, Phd
Institute for Pulmonary Rehabilitation Research,
Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany - Nandita Dandekar
Founder and Director, Pink Tree Foundation,
Pink Tree Health, Mumbai, India.
References
- Jones PW, Lamarca R, Chuecos F, et al. Characterisation and impact of reported and unreported exacerbations: results from ATTAIN. Eur Respir J. 2014;44(5):1156–1165. doi: 10.1183/09031936.00038814
- Wilkinson TM, Donaldson GC, Hurst JR, Seemungal TA, Wedzicha JA. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169(12):1298–1303. doi: 10.1164/rccm.200310-1443OC
- Leidy NK, Murray LT, Jones P, Sethi S. Performance of the EXAcerbations of chronic pulmonary disease tool patient-reported outcome measure in three clinical trials of chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2014;11(3):316–325. doi: 10.1513/AnnalsATS.201309-305OC
- Betsuyaku T, Kato M, Fujimoto K, et al. A randomized trial of symptom-based management in Japanese patients with COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:2409–2423. doi: 10.2147/COPD.S152723
- Langsetmo L, Platt RW, Ernst P, Bourbeau J. Underreporting exacerbation of chronic obstructive pulmonary disease in a longitudinal cohort. Am J Respir Crit Care Med. 2008;177(4):396–401. doi:
- Jones PW, Wang C, Chen P, Chen L, Wang D, Xia J, Yang Y, Wang Y, Ma Q. The Development of a COPD Exacerbation Recognition Tool (CERT) to Help Patients Recognize When to Seek Medical Advice. Int J Chron Obstruct Pulmon Dis. 2022 Jan 21;17:213-222. doi: 10.2147/COPD.S337644. PMID: 35087270; PMCID: PMC8789323.
- Mackay AJ, Donaldson GC, Patel AR, et al. Usefulness of the chronic obstructive pulmonary disease assessment test to evaluate severity of COPD exacerbations. Am J Respir Crit Care Med. 2012;185(11):1218–1224. doi: 10.1164/rccm.201110-1843OC.
- Jones PW, Chen WH, Wilcox TK, et al. Characterizing and quantifying the symptomatic features of COPD exacerbations. Chest. 2011;139(6):1388–1394. doi: 10.1378/chest.10-1240.
- Leidy NK, Wilcox TK, Jones PW, et al. Development of the EXAcerbations of Chronic Obstructive Pulmonary Disease Tool (EXACT): a patient-reported outcome (PRO) measure. Value Health. 2010;13(8):965–975. doi: 10.1111/j.1524-4733.2010.00772.x.
- Leidy NK, Wilcox TK, Jones PW, et al. Standardizing measurement of chronic obstructive pulmonary disease exacerbations. Reliability and validity of a patient-reported diary. Am J Respir Crit Care M ed. 2011;183(3):323–329. doi: 10.1164/rccm.201005-0762OC.
- Jones, Paul et al. “Development of a Communication Tool between Patients and Physicians for Recognizing COPD Exacerbations in Japan.” COPD vol. 20,1 (2023): 216-223. doi:10.1080/15412555.2023.2219742
- Xing, Xiangju et al. “Validation and Further Analysis of the COPD Exacerbation Recognition Tool (CERT).” Respirology (Carlton, Vic.), 10.1002/resp.70159. 19 Nov. 2025, doi:10.1002/resp.70159
- Wang, Hao et al. “Towards Better Recognition of COPD Exacerbations With Patient-Centred Reporting Tools.” Respirology (Carlton, Vic.), 10.1002/resp.70173. 25 Nov. 2025, doi:10.1002/resp.70173
- Gloeckl, Rainer et al. “Can Patient Education Lead the Way? Head-To-Head Comparison of EXACT and CERT for Early Recognition of Acute COPD Exacerbations.” Respirology (Carlton, Vic.), 10.1002/resp.70170. 30 Nov. 2025, doi:10.1002/resp.70170
- Gloeckl R, Tal-Singer R, Deussen P, et al. COPD exacerbation recognition tool: translation, linguistic, and cross-cultural validation. Chronic Obstr Pulm Dis. 2026; 13(2): 147-157. doi: http://doi.org/10.15326/jcopdf.2025.0745
Funding support provided by; AstraZeneca, Sanofi, GSK, Boehringer Ingelheim