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Diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

COPD is a clinical diagnosis, meaning there is no specific test to confirm that you have it. Unfortunately, it cannot be detected before irreversible lung damage has occurred. However, the earlier it is detected, the sooner steps can be taken to slow further damage.

Your doctor will ask you about your symptoms and medical history. A physical exam will be done. Your history and physical exam provide the most important information that is used for the diagnosis of COPD. If your doctor suspects you might have COPD, you may have one or more of the following tests to diagnose COPD and assess the severity of your disease.

Lung Tests

Pulmonary Function Tests

Many tests of lung function have been developed. Each provides slightly different information about how well your lungs are working. Pulmonary function tests are painless and noninvasive. They are performed using a machine called a spirometer. By breathing into the spirometer, your doctor can measure your lung volume and your ability to move air in and out of your lungs in a certain period of time. Your results are compared with typical findings of a healthy person your age and similar height. Your doctor can then determine to what extent your lung function is diminished. Sometimes, tests are repeated after you have been given a bronchodilator medication. This is to see if your results improve with this type of treatment.

Pulmonary function measures include:

  • Forced vital capacity (FVC)—This is the maximum volume of air that can be forcibly exhaled after inhaling as deeply as possible.
  • Residual volume (RV)—This is the amount of air that remains in the lungs when measuring vital capacity after a maximal exhalation. In persons with COPD, RV is usually increased dramatically from normal because air is trapped in the damaged lung and cannot be exhaled normally.
  • Total lung capacity (TLC)—This is the total amount of air the lungs are capable of holding. It is the combination of FVC and RV.
  • Forced expiratory volume in 1 second (FEV 1 )—This measures the volume of air that can be forcibly exhaled in one second. It represents the rate of air movement out of the lungs. FEV 1 typically declines a very small amount per year in normal persons. The decline can be several times greater in people with COPD.
  • Peak expiratory flow (PEF)—Maximum speed of exhalation after after maximal inhalation.
Carbon Monoxide Diffusing Capacity

This test measures how well your lungs transfer a small amount of carbon monoxide gas into your blood. You take a breath of air containing a very small amount of carbon monoxide from a container. The amount of carbon monoxide in your exhaled air or arterial blood is then measured.

Other Tests

Oximetry

A sensor on your finger is used. It can quickly get basic information about the amount of oxygen in your blood.

Blood Tests
  • Arterial blood gases—Analyze the amount of oxygen and carbon dioxide in your bloodstream.
  • Levels of alpha-1-antitrypsin—This is an important protein that helps protect the lungs from damage due to inflammation. Persons who develop COPD at an early age, or who develop the disease but never smoked, may have abnormally low levels of this protein due to a genetic defect.
Imaging Tests

Imaging tests are used to examine the lungs and evaluate lung damage. These may include:

  • Chest x-ray—May be normal with chronic bronchitis, but will usually show many characteristic abnormalities.
  • CT Scan—May be used to detect complications or to plan for surgery.

Revision Information

  • COPD. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115557/COPD. Updated February 9, 2017. Accessed February 22, 2017.

  • Diagnosing and treating COPD. American Lung Association website. Available at: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/diagnosing-and-treating. Updated November 30, 2016. Accessed February 22, 2017.

  • Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2017. Global Initiative for Chronic Obstructive Lung Disease website. Available at: http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd. Accessed February 22, 2017.

  • How is COPD diagnosed? National Heart, Lung, and Blood Institute (NHLBI) website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/copd/diagnosis. Updated July 31, 2013. Accessed February 22, 2017.

  • Qaseem A, Wilt TJ, Weinberger SE, et al; Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155(3):179-191.