Are further tests going to be useful to help guide diagnosis?

Let’s now have a look at some of the further tests that could guide the diagnosis.

Physical examination

• Listening to breathing – Lung auscultation
• Respiratory rate
• Is there evidence of clubbing? – clubbing is characterised by changes to fingers and toes, such as bulbous enlargement of the finger tips or toes; changes in the angle between the skin and nails; or excessive sponginess of the nail base. Clubbing can develop quickly and can be indicative of various disease processes.

If coughing:

• Chronic cough – The Chronic Cough in Adults: Make the Diagnosis and Make a Difference paper is suggested for the diagnosis of a chronic cough
• Peak expiratory flow (if asthma is suspected, or COPD if spirometry is unavailable).
• Blood test for pneumonia
• Imaging scans including chest X-ray (to detect a number of conditions such as lung cancer, TB, interstitial lung disease) or more detailed tests such as high resolution CT scans.
• Spirometry if available
• Test for pertussis (whooping cough)
• Test for TB – using acid-fast bacillus (AFB) stain or a tuberculosis (TB) smear. This is a test to determine if a person has TB or another type of mycobacterial infection.
• COVID – depends on availability

If breathless:

• This paper gives a detailed assessment process and is suggested for chronic breathlessness.
• National Institute for Health and Care Excellence (NICE) Guidelines on breathlessness
• Check blood pressure
• Blood tests (including full blood count for anaemia)
• Temperature
• Oxygen saturation
• Test for Tuberculosis (TB) – skin test/blood test

When selecting tests, choose the investigations that might give the most information about the diagnosis with the least risk to the person.