How is COPD diagnosed?

The following was originally published on May 18, 2015

How is COPD Diagnosed?

So you’re having trouble breathing and are wondering if it’s chronic obstructive pulmonary disease (COPD). You’ve called a doctor and made an appointment. Now what?

Like asthma, COPD is sometimes difficult to diagnose because there are many other diseases that may cause trouble breathing. Also like asthma, there is no one specific test to diagnose COPD.

A typical process of diagnosis involves a combination of the following.

1. Medical History. COPD usually develops over time, and after long-term (chronic) exposure to inhaled chemicals. Your answers to simple questions may show you have an increased probability of having COPD, indicating further testing is needed. Common questions are:

• Are you short of breath? Has it gotten worse over time? Does it get worse with exercise? Do you have a family history of lung disease?
• Do you have an ongoing cough? Do you cough up sputum? What color is it?
• Have you ever had regular exposure to any of the following: cigarette smoke, wood smoke, or chemicals at work.

2. Patient Assessment. Your doctor will check you over to see if you show signs of lung disease.

• Listen to your lung and heart sounds
• Check your ankles for swelling
• Check to see if your chest is expanded

3. Pulmonary Function Testing. This is a breathing test that can show your doctor:

• If you have lung disease
• What lung disease you have
• How severe it is

4. Arterial Blood Gas (ABG). Arterial blood contains freshly oxygenated blood from your lungs. It can show your doctor:

• What your oxygen levels are
• How severe your COPD is
• If you need oxygen therapy

5. X-rays and Cat Scans (CT). Seeing inside your chest can help your doctor:

• See if you have hyperexpanded airways (air trapped in your lungs due to disease)
• Check your heart size (enlarged may indicate severe COPD)
• See if you have pneumonia (a common cause of COPD flare-ups)

6. Bronchoscopy. This is not commonly performed; however, it involves inserting a scope into your airways so your doctor can:

• See if there is damage to your airways
• Remove excessive secretions that might be making it hard to breathe
• Take samples for further testing.

7. Differential Diagnosis. There are many other diseases that may mimic COPD that must be ruled out before a diagnosis of COPD can be made.

• Asthma. A chronic condition that causes shortness of breath that is reversible with treatment.
• Heart failure. Fluid gets backed up in your lungs causing wheezing and shortness of breath.
• Lung cancer. May cause localized wheezing around tumor, along with shortness of breath

8. Other Tests.

• Mucus culture. You spit mucus into a cup so it can be tested for bacterial infections, such as pneumonia 
• Electrocardiogram (EKG). This takes a picture of the electric current through your heart. It shows a doctor if lung disease has caused heart changes. 
• pH Probe. This is a test to see if you have gastrointestinal reflux (GERD). It checks to see if a backflow of stomach contents into your lungs is causing your breathing trouble.

Look, sometimes diagnosing COPD is as simple as asking a few simple questions. Sometimes it’s as easy as a simple assessment. Sometimes, however, it involves running through the gamut of tests. Every step is worth it, because once you get a proper diagnosis you will be well on your way to feeling better and living better.

Further reading:

• Is It Asthma? Here’s How To Find Out
• Global Initiative for Chronic Obstructive Lung Disease: COPD Guidelines
• National Heart Lung & Blood Institute: How is Asthma Diagnosed?
• National Jewish Health: COPD Diagnosis
• Breaking Down a Pulmonary Function Test
• Here’s All You Need To Know About Pulmonary Function Testing
• How Chronic Bronchitis Affects Your Lungs
• Understanding Oxygen and Oxygen Levels with COPD