Diagnostic Tests

In spite of the widespread incidence and seriousness of chronic obstructive lung disease, 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 COLD. In one 2002 study, nearly half of patients over 60 who regularly smoked had COPD.

Medical and Personal History

The physician will request a history that assesses the patient's risk factors. They include past and present smoking, low exercise capacity (e.g., whether the patient has trouble climbing stairs, the distance he or she can walk), and exposure to any industrial pollutants.

Physical Examination

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Appearance. The appearance of the patients may be a clue to the condition. Bluish skin tone and swelling in the legs ("the blue bloater") suggests chronic bronchitis. Healthy skin tone but having an inflated chest ("the pink puffer") suggests emphysema.

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

Chest Examination. The physician will next perform a simple examination of the chest area. Using a stethoscope, the physician will listen to the patient's breathing:

• Diminished or distant breath sounds are signs of emphysema. Tapping the chest will usually produce a hollow, drum-like sound.
• In chronic bronchitis, the physician is likely to hear wheezing or gurgling sounds.

Pulmonary Function Tests (Spirometry)

The best tests for determining the presence and managing the response to treatment of chronic obstructive lung disease are pulmonary function tests, most often spirometry. Spirometry measures the volume and force of air as it is exhaled from the lungs. The patient is asked to breathe in and to exhale forcefully into an instrument several times. The force of the air is then monitored and measured.

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