Diagnosis and Evaluation of COPD
How to Diagnose COPD
Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe progressive lung diseases such as chronic bronchitis and emphysema. Progressive lung disease is a type of the disease that gets worse with time. There were over three million deaths from COPD across the world in 2012, which accounts for 6% of the total global deaths that year.Currently, COPD affects an estimated 24 million individuals in the United States alone, and over half of these individuals have COPD symptoms and do not know it.If you follow a few simple steps, you can learn about COPD and diagnose your condition.
Recognizing the Symptoms
See your doctor.The best way to fight COPD is to see your doctor before symptoms arise. This is because symptoms of COPD often don’t appear until significant lung damage has already occurred.The best course of action is to seek medical care if you are a long-term smoker or in a high risk group.
- COPD symptoms are often ignored because they start gradually and progress over time. COPD sufferers also tend to modify their lifestyle, such as becoming less active, to minimize and disguise shortness of breath instead of getting diagnosed.
- You should seek immediate medical attention if you are in a high risk group and are also experiencing symptoms such as chronic cough, shortness of breath, or wheezing.
Watch out for excessive coughing.Once you know if you are at risk for COPD, you can start looking for the symptoms. They start out mild but increase in severity as the disease progresses. Watch for excessive coughing, which is usually worse in the mornings, which may persist for months or years. It may produce a small of amount of clear or yellow mucus. COPD leads to increased mucus production.
- Smoking paralyzes the cilia, or small hairs, in the airways. This reduces the amount of mucus that is cleared from the lungs and causes further coughing as a mechanism to clear this increased mucus. The sticky and thick consistency of mucus also makes it harder to clear.
Monitor shortness of breath.Another major symptom of COPD is shortness of breath, especially during physical activities. Shortness of breath, or difficulty breathing (dyspnea), may be the most significant symptom of COPD. This is because coughing can be caused by many other things while shortness of breath is a rarer symptom. It presents itself as a kind of air hunger, or gasping, that worsens as the disease progresses.
- You may also start to notice a shortness of breath at rest or without much activity. In these cases, supplemental oxygen may be needed as the disease progresses.
Listen for wheezing.As part of COPD, you may experience wheezing. Wheezing is when you make high-pitched, whistling sounds while breathing. It occurs in some people with COPD, particularly during physical exertion or when there are episodes of worsened symptoms. These abnormal breath sounds are heard best during exhalations, or when breathing out.
- Bronchoconstriction, a decrease in the diameter of or mucus blockage in the airways, produces this characteristic lung sound.
Look for changes in your chest.As COPD progresses, you may develop a barrel chest. A barrel chest may be evident upon visual examination of the chest. It represents the over-inflation of the lungs, which cause the ribs to expand to accommodate the excess air and leads to the chest resembling the shape of a barrel.
- You may also experience chest tightness, which includes any type of pain or discomfort occurring between the upper belly and lower neck areas. Although it can signal multiple disorders, chest tightness in combination with cough and wheezing is indicative of COPD.
Recognize physical differences.There are a few physical changes that you may recognize as COPD progresses. You may develop cyanosis, which refers to the blue discoloration of the lips or fingernail beds. It represents low levels of oxygen in the blood, which is referred to as hypoxemia. Hypoxemia may be a late consequence of COPD and usually requires treatment with supplemental oxygen.
- You also may notice unintended weight loss, which is usually present only in advanced stages of COPD. As COPD progresses, it requires larger and larger amounts of energy to breathe. COPD robs the body of vital calories that should be going toward the maintenance of the body.
- You may also have swelling of your feet and legs or the veins in your neck if you have had COPD for a long time.
Have a lung function test.When you see your doctor for diagnosis, he will start with a lung function test. Spirometry, the most common lung function test, is a simple, non-invasive test that measures how much air your lungs can hold and how fast you can blow air out of your lungs. Spirometry has the ability to detect COPD before the development of lung symptoms, can be used to track disease progression, and can monitor the effectiveness of your treatment.
- Spirometry can be used to stage, or measure of the extent, of COPD. Stage 1 is mild COPD, where Forced Expired Volume in 1 second (FEV1) >80% of predicted. At this stage, the individual may not be aware that lung function is abnormal.
- Stage 2, which is moderate COPD, has a FEV1 of 50-79%. This is the stage at which most seek medical attention for their symptoms.
- Stage 3, which is severe COPD, has a FEV1 of 30-49%. The final stage, stage 4, is very severe COPD and has a FEV1 <30%. At this stage, quality of life is very impaired and symptom episodes may be life-threatening.
- These staging systems have limited value in predicting death from COPD.
- In addition, your doctor may recommend other tests, such as blood tests, cultures of your sputum, pulse oximetry, tests of your heart, or a test of your lung function while walking.
Get a chest x-ray (CXR).Your doctor may also perform a CXR. These are usually abnormal in severe COPD, but may not show changes in up to 50% of those with a moderate form of the disease. Characteristic findings from CXR include hyperinflation of the lungs, flattening of the domes of the diaphragm, and tapering of the pulmonary vessels as they move to the periphery of the lung fields.
- CXR can document emphysema and can also be utilized to rule out other lung problems or heart failure.
Undergo a computed tomography (CT) scan.Another method of diagnosis of COPD is a CT scan of your chest. A CT scan may be helpful in detecting emphysema and may also be helpful in determining if you would benefit from surgery for COPD. Doctors also use CT scans as a method of lung cancer screening, though it has not been uniformly adopted in medicine.
- A CT scan of the chest should not be used routinely to diagnose COPD unless other methods are used as well.
Analyze your arterial blood gas (ABG) levels.Your doctor may want to analyze your ABG levels. An ABG analysis is a blood test that measures the oxygen level in your blood using a sample of blood taken from an artery. The results of this test can show the severity of your COPD and how it is affecting you.
- ABG analysis can also be used to determine if you need oxygen therapy.
Learn about the condition.COPD includes two main conditions: chronic bronchitis and emphysema. There is a short-term type of bronchitis, but chronic bronchitis is one of the major diseases that make up COPD. Chronic bronchitis is noted by the documentation of a productive cough being present for at least three months out of a year for two consecutive years. Chronic bronchitis causes inflammation and increased mucus production in the bronchial tubes, or the airways that carry air to our lungs. The process can block airways and make it difficult to breathe.
- Emphysema, the other major disease under the COPD term, is characterized by an enlargement of alveoli, or air sacs, in the lungs and the destruction of the walls of these air sacs. This disease will eventually lead to decreased gas exchange in the lungs, making it harder to breathe.
Know the causes.COPD is caused by long-term exposure to irritants that damage the lungs. Smoking tobacco is by far the most common cause of COPD. Breathing in secondhand smoke and air pollution can also contribute to the development of COPD.
- Cigar, pipe, and marijuana smokers are also at increased risk of developing COPD.
- Secondhand smoke represents the smoke in the air as a result of other people smoking.
- People with asthma, especially if they smoke, are at higher risk of developing COPD.
- There are other rare medical conditions, especially connective tissue disorders, that are associated with COPD. This includes an alpha-1-antitrypsin deficiency, a genetic disorder that causes low levels of a specific protein that protects the lungs, as well as several others such as Marfan syndrome and Ehlers-Danlos syndrome.
Understand the environmental risk.You are at risk of COPD if you have had excessive occupational exposure to dust and chemical fumes and gases. Long-term exposure to these in the workplace can irritate and inflame the lungs. Dust from materials such as wood, cotton, coal, asbestos, silica, talc, cereal grains, coffee, pesticides, drug or enzyme powders, metals, and fiberglass can damage the lungs and lead to an increased risk of COPD.
- Fumes from metals and other substances can also increase risk of developing COPD. These jobs include welding, smelting, furnace work, pottery making, plastics manufacture, and rubber operations.
- Exposure to gases such as formaldehyde, ammonia, chlorine, sulfur dioxide, ozone, and nitrogen oxide can also increase risk of developing COPD.
To diagnose COPD, make an appointment with your doctor as soon as you notice the symptoms, which include coughing, shortness of breath, and wheezing. You can also look out for physical changes, like your lips or fingernail beds becoming blue, both of which are signs of a lack of oxygen in your blood. At the doctor's office, take a lung function test, like spirometry, which measures how much air your lungs can hold and how quickly you can breathe out. Alternatively, you may need to have a CT scan of your chest or a chest x-ray to confirm diagnosis.
- See your doctor if you have a cough that is not getting better or keeps coming back, shortness of breath, chest pain or tightness, or wheezing.
- Smoking can increase your risk of COPD, or can increase it's severity if you already have it. Talk to your doctor about quitting smoking.
Sources and Citations
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Video: How is COPD diagnosed?
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