The diagnosis of Chronic Obstructive Pulmonary Disease, commonly known as COPD, poses a particular problem for people with this disease and health care practitioners who treat them. This page helps to define COPD and discusses how to diagnose COPD on symptom history, physical assessment, and lung spirometry testing.
COPD is the 3rd leading cause of death in the United States (2011) and also causes long-term disability. The number of people who have COPD is on the rise --- more than 12 million are currently diagnosed with it. And it is estimated that another 12 million may have COPD but not realize it.
What is COPD?
COPD is an obstructive lung disease which means the person has difficulty "breathing air out" of the lungs which contributes to hyperinflation (air trapping in the lungs), increasing shortness of breath (dyspnea) and breathlessness. COPD includes those with emphysema (em-fi-SE-ma), chronic bronchitis in varying degrees of severity caused by a variety of factors, and those who have had chronic poorly controlled asthma. A person may have one or more of these lung diseases at the same time. The lungs of COPD diagnosed individuals are constantly swollen or inflammed. The lungs may also have large areas of destruction, forming large cavities within the airways known as bullae.
The Global Initiative for Chronic Obstructive Lung Disease (also known as "GOLD") defines COPD as follows:
- A preventable and treatable disease characterized by chronic airflow limitation that is not fully reversible. Airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs.
- Chronic obstructive bronchitis is defined as partially reversible airflow limitation as well as the presence of chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded.
- Emphysema is defined as an abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
People with COPD are susceptible to infections of the airways. COPD can present itself as a whole body (systemic) disease as the inflammation is not limited to just the lung. COPD contributes towards weight loss, overall muscle weakness, heart disease and osteoporosis (brittle bones).
In general, symptoms of COPD don't appear until significant lung damage has occurred, and the symptoms usually worsen over time. People with COPD are also likely to experience episodes called exacerbations, during which their symptoms suddenly get much worse. Beyond this, signs and symptoms of COPD can vary, depending on which lung disease is most prominent. It's also possible to have many of these symptoms at the same time.
The diagnosis of COPD is suspected on the basis of person's medical history, physical exam, and confirmed by lung spirometry testing - also called pulmonary function testing (PFT). Spirometry should be used to assess how well you can breathe air in and out of the lungs and together with a thorough history and physical exam can help the doctor give a proper diagnosis. Spirometry testing is necessary for the diagnosis of COPD.
Spirometry can detect COPD long before its symptoms appear. Doctors also may use the results from this test to find out how severe your COPD or other lung disease is and to help set your treatment goals.
Your doctor may recommend other tests, such as:
- A chest x ray or chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms.
- An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The test can help find out how severe your COPD is and whether you may need oxygen therapy.
It is uncommon to diagnose COPD under the age of 35. Typically, the person will be a current smoker or former smoker with at least 10 pack years (one pack year is someone who smokes 20 cigarettes a day for one year). The person usually has a cough with mucous or sputum production and shortness of breath.
Note: Alpha-1 Antitrypsin Deficiency (AAT) is a genetic form of lung disease that some people are born with (inherited and passed generation to generation) that causes similar signs, symptoms, and lung destruction. AAT deficient individuals typically do not get relief of symptoms when using inhaled or oral medications used for COPD and progressively become sicker and more short of breath over a short span of time. There are different treatment options for this type of inherited condition. A simple inexpensive blood test by your physician is used to confirm this diagnosis (click on link at the bottom of this page for more details).
How Does COPD Differ from Asthma?
Although COPD and Asthma have similar symptoms such as coughing and wheezing, they are two distinct conditions due to how the disease developed, frequency of symptoms and reversibility of airway obstruction.
1. The onset of asthma typically occurs during childhood or teenage years where COPD most often develops in current and former smokers who are in their mid-40s. Note: Asthma can develop at any age even in elderly adults - talk to your doctor if you think you have asthma or COPD.
2. Asthma episodes or exacerbations (flare-ups) -- are those individuals with frequently occurring wheezing, shortness of breath, chest tightness and cough -- and who often have specific and sometimes easy to identify triggers of their symptoms especially allergens - such as dust, pollen, pet dander, or exercise induced. However, flare-ups in persons with COPD are commonly caused by respiratory tract infections such as those the common cold or other upper respiratory viruses.
3. With treatment, people with asthma have near-normal lung function and are symptom-free between asthma flare-ups. People with COPD very rarely experience a day without symptoms. Airflow obstruction in COPD sufferers is only partially reversible with smoking cessation and quick-relief bronchodilator (such as Albuterol or Levalbuterol) use.
4. It is not uncommon nor impossible to have both Asthma and COPD. Many adults had asthma or asthma-like symptoms as a child and as they grew up had fewer symptoms or no longer had symptoms. However, due to exposure to smoke either by smoking, environmental (Coal Dust) or work hazards exposure the person has now developed COPD and has Asthma. The myth is that "you out grow asthma", but asthma never goes away - it is a life-long issue even though a person can be symptom-free for many years at a time.
Despite these distinctions, Asthma is often misdiagnosed and persons with Asthma are treated instead just for COPD. The first-line therapy for patients with persistent asthma is taking an inhaled corticosteroid "controller medication" daily, and a "quick-relief medication" bronchodilator to control immediate symptoms such as wheezing only when they need it. However, the reverse is true for the treatment of COPD. Bronchodilators (such as Albuterol) are the first-line daily treatment for COPD.Treatment with inhaled corticosteroids is not typically prescribed for patients whose COPD, however new treatment options are continually being developed as more is learned on how to improve the management of COPD.
Risk Factors for Developing COPD
COPD should also be considered if you have one or more of the following risk factors:
- Exposure to tobacco smoke.This is the number one reason for developing COPD. History of tobacco use or prolonged exposure to secondhand or environmental smoke. The most significant risk factor for developing COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Symptoms of COPD usually appear about 10 years after you start smoking. Pipe smokers, cigar smokers and people exposed to any amount of secondhand smoke also are at risk.
- Occupational exposure to dusts and chemicals. Occupations with exposure to dust and chemicals (e.g., firefighters, welders). Long-term exposure to chemical fumes, vapors and dusts can irritate and inflame your lungs.
- Gastroesophageal Reflux Disease (GERD). This condition is a severe form of acid reflux — which is the backflow of acid and other stomach contents into your esophagus. GERD can make COPD worse.
- Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin.
- Genetics. A rare genetic disorder known as alpha-1-antitrypsin deficiency is the source of a few cases of COPD. Researchers suspect that other genetic factors may also make certain smokers more susceptible to the disease.
- Asthma - a chronic lung disease that has no cure
- Chronic respiratory infections - frequent or yearly occurring illnesses involving the lungs
Symptoms of COPD
COPD may be indicated by the presence of one of the following symptoms:
- Chronic cough (duration greater than three months) with or without sputum production
- Dyspnea (shortness of breath) with or without wheezing
Signs/symptoms for which COPD may be suspected:
- Wheezing, prolonged expiratory phase of respiration (longer than normal time needed to exhale air from lungs while breathing), rhonchi (lung sound indicating chest congestion is present) and cough
- Dyspnea (shortness of breath with exertion or at rest)
- Chronic sputum production (mucous)
- Hyperinflation of the chest with increased anterior-posterior (A-P) diameter
- Use of accessory muscles of respiration (using all chest and neck muscles to breath)
- Pursed-lip breathing (breathing in through the nose and out through pursed-lips)
- Signs of cor pulmonale (enlargement of the Left-side of the heart):
If you or someone you know has symptoms such as chronic coughing, shortness of breath or wheezing, see your doctor for a simple breathing test. By taking steps now, and talking with your doctor about treatment options, you can breathe better and enjoy a more active life.
American Lung Association
Breathing Better with COPD
National Heart, Lung, and Blood Institute
National Lung Health Education Program
West Virginia COPD Task Force
What is Alpha-1 Antitrypsin Deficiency?
FDA approves new COPD drug
Cabell Huntington Hospital Pulmonary Rehabilitation Services
Charleston Area Medical Center Pulmonary Rehabilitation Services