Diagnosing Chronic Obstructive Lung Disease

Diagnostic Tests

Despite the widespread incidence and seriousness of COPD, studies strongly suggest that it is underdiagnosed, especially in women. Some experts recommend that any adult smoker who complains of a daily cough should be screened for COPD. In one study, nearly half of patients over age 60 who regularly smoked had COPD. Anyone who has a chronic cough, increased phlegm production, or breathing difficulty that gets worse over time should be checked for the disease.

Medical and Personal History

The doctor will request a history that evaluates the patient's risk factors. Risk factors include:

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• Past and present smoking
• Exposure to industrial pollutants at work
• Family history of alpha-1 antitrypsin deficiency
• Low exercise capacity (such as trouble climbing stairs or difficulty walking for more than a certain distance)
• Past and present smoking

Physical Examination

Appearance. There are usually no changes in physical appearance in people with mild-to-moderate COPD. In advanced COPD, patients with emphysema may be wasted and thin, with normal-colored pink skin. Those with chronic bronchitis may have bluish lips and fingers, be obese, and may have swollen feet and legs. Breathing may be rapid and shallow, done through pursed lips, and it may take longer to breathe out.

The patient will be asked to cough and produce phlegm, if possible.

Chest Examination. The physician will next perform a simple examination of the chest area with a stethoscope to listen for:

• Crepitations, a noise resembling a paper bag being rumpled
• Reduced or distant breath sounds
• Signs of pulmonary hypertension
• Wheezing or gurgling sounds

Other findings may include:

• Breathlessness when the patient lies flat
• Increased pressure in the veins

Pulmonary Function Tests (Spirometry)

The best tests for diagnosing COPD and seeing how well it responds to treatment are pulmonary function tests. The gold-standard test for patients with respiratory symptoms such as shortness of breath is spirometry. Spirometry measures the volume and force of air as it is exhaled from the lungs. It measures airway obstruction, can identify COPD early, and the results are standardized so they are always consistent.

Because it is easy, reliable, and relatively inexpensive, spirometry is an effective method to help health professionals diagnose COPD early, when it is most treatable. However, spirometry is underused, which may be due to a lack of access and training, as well as cost and time constraints.