How is COPD Diagnosed?

The pathways to the diagnosis of COPD are outlined as follows:

COPD Diagnosis

Supported Investigation

• X-ray chest
• High-resolution computed tomography (HRCT)
• Sputum for AFB
• History taking: This includes symptoms, and detailed medical history (please see symptoms and detailed medical history below).
• Physical examination: Physical examination is rarely diagnostic in COPD, although it is an important part of patient care. Physical signs of airflow limitation are usually not present until there is significant impairment of lung function.
• Spirometric evaluation: Spirometry is required to establish the diagnosis of COPD. A post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD in patients with appropriate history.

Symptoms

Dyspnea: Persistent, progressive over time, and characteristically worse with exertion. Typical COPD patients describe their dyspnea as a sense of increased effort to breathe, chest heaviness, air hunger, or gasping. However, the terms may vary both individually and culturally.

Cough: Initially, the cough may be intermittent, but subsequently may be present daily, often throughout the day. A chronic cough in COPD may be productive or unproductive.

Sputum production: COPD patients commonly raise small quantities of tenacious sputum with coughing. Sputum production can be intermittent with periods of flare-up interspersed with periods of remission. Sputum production is often difficult to evaluate because patients may swallow sputum rather than expectorate it, a habit that is subject to significant cultural and sex variation. Coughing up blood should never be assumed to be due to COPD – always check for other causes such as cancer, or TB.

Wheezing and chest tightness: Wheezing and chest tightness are symptoms that may vary between days, and over the course of a single day. Some variability happens in COPD, but marked variability may be due to asthma (which overlaps in about one in 10 adults).

Detailed Medical History

• Risk factors
• Past medical history, family history of COPD or other CRDs
• History of exacerbations or hospitalisations due to respiratory disorders
• Comorbidities
• Social and family support to the patient