Medical Diagnosis of Chronic Obstructive Pulmonary Disease

Medical Diagnosis of Chronic Obstructive Pulmonary Disease

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Millions of Americans are disabled by the effects of COPD.

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Chronic obstructive pulmonary disease is a complex lung disorder characterized by reduced airflow and airway inflammation. COPD is slowly progressive and generally irreversible. Approximately 12 million people in the United States suffer from COPD, and the disease is increasing in prevalence, according to a 2012 review in "Thorax." Several disorders may contribute to or occur with COPD, including asthma, chronic bronchitis, chronic bronchiolitis and pulmonary emphysema. The medical diagnosis of COPD is based on your symptoms, risk factors, physical examination and pulmonary function tests.

Symptom Complex

COPD limits your ability to move air through your lungs. This may prevent adequate oxygen delivery to your tissues, particularly when your oxygen need increases, such as during exercise. The airway inflammation associated with COPD triggers excess mucus production. Thus, progressive shortness of breath at rest, decreased exercise tolerance, chronic cough and persistent phlegm production are among the "symptom complex" seen in people with COPD. These symptoms can be caused by other conditions, however, so their presence is not diagnostic of COPD.

Risk Factors

A number of medical conditions, behaviors and exposures can increase your risk for COPD. Your doctor will gather information about these risk factors to help confirm your diagnosis. Cigarette smoking is the primary cause of COPD worldwide. Chronic or repeated exposure to other aerosolized agents, such as wood smoke or occupational dusts and chemicals, is another major contributor. People with asthma, severe allergies or a family history of chronic respiratory disease are also at increased risk for COPD.

Physical Examination

A physical examination is an important part of evaluating you for any disease and is helpful during a workup for COPD. However, physical examination alone is rarely diagnostic for COPD. Further, physical signs of COPD may not appear until the disease is quite advanced. Nevertheless, your doctor will listen to your lungs to check for wheezing or other unusual breathing noises. Examination of your nose and throat may reveal signs of allergies. People with advanced COPD are often underweight, their breathing may appear labored and they may have "barrel chests" or signs of heart failure, such as swollen feet.

Pulmonary Function Testing

While your history, symptoms and physical examination are important for diagnosing COPD, the "gold standard" of diagnosis is lung testing called spirometry. Spirometry is performed by taking a deep breath and exhaling as quickly as possible through a device that measures airflow. This simple test measures your total lung capacity and your ability to force air out of your lungs.

Spirometry can be performed in many physician offices, but your healthcare provider may refer you for more sophisticated pulmonary function tests. The mathematical ratio between the amount of air you can blow out in the first second (FEV1) and the total amount of air you can blow out (FVC) will determine whether you have COPD. A FEV1/FVC ratio below 0.7 is highly suggestive of COPD. The severity of your disease can then be determined by comparing your FEV1 to that of normal people. More severe COPD is associated with lower FEV1 values.


COPD is a progressive disease but it can be treated. If you are diagnosed with COPD, the most important therapeutic measure is to eliminate exposure to agents that could be contributing to your disease. If you smoke, quitting is essential. Occupational exposures, asthma and other aggravating factors must also be addressed.

A wide array of treatments -- such as inhalers, mucus-dissolving agents, antiinflammatory drugs and oxygen -- are used to help people with COPD. Pulmonary rehabilitation, a specific form of physical therapy, may also be helpful. Your doctor will determine which treatments are best for you.