Diagnosis and Evaluation of COPD
Symptoms and Diagnosis of COPD
There are two main types of chronic obstructive pulmonary disease (COPD): emphysema and chronic bronchitis. Most people with COPD suffer from both. (1)
COPD, which causes airflow obstruction and difficulty breathing, is associated with several common symptoms, such as a cough, wheezing, and chest tightness. A patient’s specific signs and severity can vary, and symptoms may worsen or improve over time. The disease can also lead to a range of complications.
What Causes COPD Symptoms?
When you inhale, air travels into the lungs through breathing tubes or airways called bronchi, which branch off into smaller airways called bronchioles.
At the end of each bronchiole is a grape-like cluster of air sacs called alveoli, which transport oxygen to and carbon dioxide from the bloodstream through its thin walls in a process called gas exchange.
In people with COPD, several factors can cause a decrease in airflow, including:
- The loss of elasticity of the airways and alveoli, which can trap air in the lungs
- The destruction of the alveolar walls, which reduces the overall surface area available for gas exchange
- The thickening of the airways due to inflammation
- The overproduction of mucus, which clogs the airways
These contributing factors can lead to various symptoms. Recognizing COPD symptoms is critical to early detection of the disease and successful treatment.
What Are Common COPD Symptoms?
Many people with COPD don’t have obvious symptoms until the disease is in advanced stages. The symptoms most commonly associated with COPD include:
- A nagging cough (referred to as “smoker’s cough”), worse in the morning, which may contain mucus, particularly in the case of chronic bronchitis
- Dyspnea, or shortness of breath that worsens with mild activity
- Chest tightness
- Constant fatigue, which often results from the decreased muscle strength associated with a long-term inability to exercise
- Frequent respiratory infections, including acute bronchitis (in emphysema patients) and pneumonia
- Cyanosis, a blueness of the lips and fingernail beds, which develops from tissues not getting an adequate amount of oxygen
- Barrel chest from the lungs being chronically overinflated with air (in emphysema)
- Reduced appetite and weight loss, resulting from the increased energy required to breathe
- Swollen ankles, feet, or legs, which can signal more severe COPD
People with COPD often experience exacerbations, or periods of time when symptoms flare up. “An exacerbation is when a chronic disease gets worse for some reason. With COPD, this is usually because of infection,” says Richard Castriotta, MD, director of the division of pulmonary and sleep medicine at the University of Texas Medical School in Houston. Exacerbations can also occur when environmental air pollution increases.
How Is COPD Diagnosed?
To determine whether you have COPD, your doctor will begin by asking you questions regarding your:
- Smoking habits, since smoking is the most common cause of COPD, accounting for as many as eight out of 10 COPD-related deaths, according to the Centers for Disease Control and Prevention (2)
- Exposure to airborne irritants, toxins, and pollution in the home and at work
- Family history of COPD and alpha-1 antitrypsin (A1AT) deficiency, a genetic disorder that can (rarely) cause emphysema (3)
- Respiratory allergies, and frequency and duration of colds and cough
After getting your medical history, your doctor will do a physical examination to inspect the function of your lungs and heart, and look for other visible signs of COPD, such as cyanosis (blueness of the lips and fingernail beds).
What Tests Are There for Lung Function?
Your doctor may order one or more lung function tests, such as:
- Spirometry This involves blowing into a tube connected to a spirometer, a machine that measures the airflow into and out of the lungs. This is the standard respiratory function test used for the detection of COPD, and it is frequently the only test needed to diagnose the condition. (4)
- Bronchial Provocation Test In this test, the patient undergoes spirometry after breathing in a certain drug (methacholine or a histamine) to evaluate the sensitivity of your lungs. This test is rarely ordered.
- Exercise Tolerance Test This can identify dyspnea and evaluate how exercise affects the ability of your heart and lungs to provide oxygen to, and remove carbon dioxide from, the bloodstream. This test is rarely done to diagnose COPD but rather to explore alternate diagnoses.
- Exercise for Desaturation Test This test measures your body's oxygen needs while at rest and during exercise. This is commonly measured during the six-minute walk test.
Are There Others Tests for COPD?
Your doctor might also order blood tests and imaging scans, such as:
- Arterial Blood Gas Test This evaluates your lungs' gas exchange capabilities by measuring the amounts of oxygen and carbon dioxide in your blood.
- A1AT Deficiency Blood Test
- Chest X-raysX-rays are used to look for lung enlargement, bronchial scarring, and the formation of air-filled cavities in the lungs called bullae.
- Computerized Tomography (CT) Scans CT scans provide more information than typical X-rays, such as whether there is airway inflammation.
Other diagnostic tests may also be necessary, such as a heart test called electrocardiogram (EKG), bronchoscopy (where a thin tube with a camera is inserted into the airways to examine the lungs), and a lung or bronchial biopsy.
Video: COPD - Causes, Symptoms and Treatment Options
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