COPD Tests & Diagnosis
In diagnosing chronic obstructive pulmonary disorder (COPD), your doctor will consider your medical and family histories, signs and symptoms of the disease, and results of diagnostic testing. The chance of a person having COPD increases if he has a relative with the disease. Also, tobacco smoking and the presence of emphysema or chronic bronchitis increase the risk of developing COPD.
As part of recording your medical history, your physician will ask if you currently smoke tobacco cigarettes or if you did in the past (quitting could protect you from developing COPD). Also, he will probably ask if you have ever experienced lung irritants such as chemical fumes, dust, second-hand smoke or air pollution. He may inquire as to whether or not you ever had a persistent cough with mucus production.
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The following is a list of diagnostic tests available to test for COPD.
Physical check up: Your doctor will listen to your heart and lungs with a stethoscope as you breathe in and out. He will listen for emphysema and bronchitis-like breaths, gurgling sounds, crepitations, prolonged exhalations, wheezing and diminished or distant breath sounds. He will also check for breathing through pursed lips, substantial weight loss, bluish lips, and other signs of COPD.
Chest X-ray: Images taken in a chest X-ray may show emphysema, which is one of the main causes of COPD, and rule out other lung problems that may present similar symptoms as COPD, such as heart failure and lung cancer. Signs of COPD found in an x-ray may include a flattened diaphragm, very large amounts of air spaces in the lung and exaggerated lung inflation in the chest cavity.
Computerized tomography (CT scan): A CT scan coalesces multiple X-ray images taken at various different angles and uses these images to create cross-sectional images. A CT scan of the lungs may detect emphysema and rule out other lung problems.
Sputum examination: Sputum (the mucus that is coughed up) can aid in the identification of the root of your lung problems. Also, analyzing sputum can facilitate in the process of ruling-out lung cancer.
Pulse Oximetry: This test measures oxygen in the bloodstream via a probe on the finger or ear lobe. The probe emits two lights to determine the correlative value of the amounts of each light absorbed by the blood as it relates to the amount of oxygen carried by the red blood cells.
Arterial blood gas analysis: This is a blood test that measures how well the lungs are taking in oxygen and putting it into the bloodstream and removing carbon dioxide from the blood. An arterial blood gas test determines the amounts (saturations) of both oxygen and carbon dioxide in the blood. Patients with low oxygen (hypoxia) may benefit from oxygen therapy. Patients with hypoxia and high carbon dioxide levels (hypercapnia) often have chronic bronchitis, and sometimes also emphysema (COPD is both emphysema and chronic bronchitis).
Spirometry: This is the “gold standard” lung function test and the most significant diagnostic test in for COPD and for determining its progressive stage. The test involves blowing air as hard as the patient can from the mouth into a large tube connected to a spirometer, a machine that measures how much air the lungs can contain upon inhalation and how quickly the lungs can empty themselves of air during exhalation. It also calculates the force of the air as it is exhaled from the lungs as well as any present airway obstruction. Spirometry testing yields consistent readings, so the results are reliable and can identify premature cases of COPD even if no symptoms are yet present. The two values determined from the spirometry are the following:
Forced vital capacity (FVC): FVC is the maximum amount of air that can be exhaled with force (an indicative measurement of lung volume, functioning of air passages in the lungs and lung elasticity).
-Forced expiratory volume in one second (FEV1): FEV1 is the maximum amount of air exhaled in one second (an indication of COPD if -FEV1 measurement is low and declining over time). Test results indicate the following diagnoses:
–An FEV1 of 50-80% indicates a moderate case of COPD
–An FEV1 of 30-50% indicates a severe case of COPD
For diagnostic purposes, the ratio of FEV1/FVC is less than 70%, even if the FEV1 is less than 50% or more than 80%.
Carbon Monoxide Diffusing Capacity (DLCO): This test determines how well the lungs exchange gases with the blood. No eating, smoking or exercising is to be done before the test. In the process of testing, the patient inhales a gaseous mixture of helium, oxygen and carbon monoxide and holds his breath for about 10 seconds, at which time the technician records inhaled gas levels. The patient then exhales and the gas levels are then analyzed again.
Nitric Oxide (NO) Measurements: The amount of NO in the exhaled breath can be indicative of a COPD diagnosis. Most patients with COPD have NO levels that are lower than normal, as they are unable to fully exhale.
Alpha-1 antitrypsin deficiency test: This is used to test for the defensive enzyme alpha-1 antitrypsin in COPD patients who developed emphysema at a young age and are nonsmokers.
Bronchodilator Challenge: COPD patients do not usually respond greatly to bronchodilation treatments (as are used for patients with asthma). This test distinguishes between patients with asthma and those with COPD.
Every COPD patient has a unique case, involving his very own symptoms, severity, medical history and prognosis. Talk with your doctor about the various tests available to diagnose and monitor the progression and treatment of COPD. Ask your health care provider which of these diagnostic tests are right for your own COPD case.