Diagnosing COPD

Diagnosing COPD at BIDMC

Symptoms, risk factors and test results can help doctors determine if you have chronic obstructive pulmonary disease (COPD).

COPD Symptoms and Risk Factors

Many patients may not notice the symptoms of COPD in its early stages, as the disease can develop over a long period of time without a person experiencing shortness of breath. If you experience any of these symptoms or are at risk for COPD, it is important to talk with your doctor right away.

A cough with mucus production that does not go away
Shortness of breath and increased breathlessness
Chest tightness and wheezing
A history of smoking
Frequent exposure to lung irritants such as secondhand smoke, cleaning chemicals and other pollutants
A family history of COPD

Types of COPD

Emphysema and chronic bronchitis are the two most common forms of chronic obstructive pulmonary disease. Some cases of COPD have also been linked to genetics.

Emphysema

Emphysema occurs when the alveoli, or air sacs, in the lungs become damaged. The alveoli inflate and deflate as you breathe, exchanging the oxygen in the lungs. When the alveoli are damaged, the body cannot properly exchange the oxygen, and the airflow out of the body becomes blocked, making it difficult to breathe.

The most common cause of emphysema is smoking. Quitting smoking before emphysema develops can help to prevent it; quitting after emphysema has been diagnosed can help keep it from getting worse.

Chronic Bronchitis

Chronic bronchitis is a serious condition when the bronchial tubes, the tubes that carry air to and from your lungs, become inflamed, causing a continuous cough with mucus. Wheezing and chest discomfort can also occur, and breathing can become very quick, as the bronchial tubes cannot allow a lot of air to flow in and out. The bronchial tubes can be further irritated by viruses or bacteria, resulting in "flare-ups" when symptoms can be worse for a period of time.

Smoking is also a major cause of chronic bronchitis, but frequent exposure to lung irritants, including tobacco smoke, air pollution, or dust, fumes, and vapors from a specific work environment can also cause or exacerbate the symptoms of the condition.

Alpha-1 Antitrypsin Deficiency (AATD)

AATD is the most common genetic risk factor for COPD, as some people who develop the disease are non-smokers or have never had frequent exposure to air pollutants. Alpha-1 Antitrypsin is a protein found in the bloodstream; without it, the lungs deteriorate as they are attacked by white blood cells. Anyone diagnosed with COPD should be tested for Alpha-1.

Research is ongoing to determine whether there are other genetic dispositions that play a role in the development of COPD.

Diagnostic Tests

Pulmonary (lung) Function Tests (PFTs)

The most common lung function test is spirometry, a painless procedure. Patients blow into a tube attached to a machine to measure the amount of air the lungs can hold and how long it takes to exhale. Spirometry can often detect COPD before symptoms begin.

Blood Tests

Lungs bring oxygen into the blood and remove carbon dioxide. Blood tests measure levels of oxygen and carbon dioxide to determine if the lungs are working properly. Doctors may also order blood tests to assess nicotine levels, and to check levels of the Alpha-1 Antitrypsin protein (AAT). People with low levels of AAT are at risk for lung diseases such as emphysema.

Chest X-ray and CT Scan

Doctors order X-rays or scans for detailed images of the lungs, and to rule out heart failure or other lung problems. These diagnostic procedures are essential and the doses administered are reduced to the absolute minimum so as not to harm the patient. A CT scan can also help determine how widespread COPD is, and if a patient might benefit from a lung volume reduction procedure or other procedure.

Additional tests may include an echocardiogram (an ultrasound test to check heart structure and function); cardiopulmonary exercise testing (on a bike or treadmill to assess how well the heart and lungs work together); or a sleep study (to assess COPD-related sleep disturbances).

Multidisciplinary Case Conference

Specialists in our COPD Clinic review test results in a team case conference, and then together create an individualized treatment plan. The conference includes physicians and specialists from general pulmonology, interventional pulmonology, thoracic (chest) surgery, thoracic radiology, palliative (comfort) care, and pulmonary rehabilitation. Our team approach among different specialists helps ensure precise diagnosis and treatment, and well-coordinated care for our patients.