Diagnosis
To make an accurate diagnosis of COPD requires consideration of a variety of areas:
- The full clinical history
- The presentation
- Clinical examination
- Spirometry
- Reversibility testing
- The exclusion of alternative diagnosis
An accurate diagnosis must be made using
- History
- Limited Physical Examination
- Pulmonary Function Tests
- History
- Age of onset
- Smoking History (No. of pack years smoked)
- Family and previous history
- Occupation
1. History
Asthma
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COPD
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Family History
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Positive FH of asthma-resources/atopy
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+/- FH COPD
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Personal History
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Previous asthma or history suggestive of childhood asthma
Atopic illness
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Fit childhood – but possible history of severe lower respiratory infection
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Social History
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+/- current or ex-smoker
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Current or ex-smoker with 20+ pack years
Possible significant occupational exposure
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Age
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Symptoms often at an arly age
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Over 35
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Presentation
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Slowly progressive shortness of breath on exertion |
Wheeze/cough – often nocturnal |
Cough +/- sputum – particularly in the morning no nocturnal disturbance
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‘Good days and bad days’
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No variation from day-to-day
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2. The Basic Examination
It is helpful to look at the shape of the patient’s chest and their pattern of breathing.
- Patients are abnormally breathless
- Overinflation of the lungs – barrel shaped appearance
Possibly leading to displacement of abdominal organs, may make the patient appear ‘pot bellied’
- Ask the patient to cough and listen carefully (productive sound of excess airway secretions and the wheeze of airflow obstruction)
Mild COPD is largely asymptomatic and physical examination is likely to be normal. These patients may only be detected using a spirometer.
3. Pulmonary Function Test
Simple pulmonary function tests are done for two main reasons in COPD.
- To make the diagnosis of airway obstruction
- To assess the progression of the disease
(See spirometry section).
Further Investigations
- Alpha-1 antitrypsin
If early onset, minimal smoking history or family history
- Radiology
At diagnosis, all people should undergo chest X-ray. This may show hyperinflation, flat hemidiaphragms, reduced peripheral vascular markings, and bullae. Chest X-ray also helps to exclude other serious lung pathology, such as lung cancer, which may have precipitated the presentation
[British Thoracic Society, 1997].
- Full blood count
In order to rule out anaemia or polycythaemia (the latter indicative of chronic hypoxia).
- ECG
To assess cardiac status
- Pulse Oximetry
To monitor the saturation of a patients haemoglobin
- Sputum Culture
To identify organisms if sputum is persistently present and purulent
Useful Links
Diagnosing Severity of COPD...
Management of Stable COPD...
Performing Spirometry...
The Treatment of Exacerbations in COPD...