Diagnosis of COPD

There is no one single test that can confirm a diagnosis of COPD.

In addition to a relevant clinical history and spirometry, at the time of initial diagnosis the patient should undergo the following investigations [4]:

  • Chest x-ray (CXR) to exclude other pathology
  • Full blood count (FBC) to identify anaemia and polycythaemia
  • Calculation of body mass index

Additional investigations to consider depending on individual factors may be [4]:

  • Serial home peak flow measurements to exclude asthma if diagnostic doubt
  • Alpha 1 antitrypsin if early onset of symptoms, minimal smoking history or a relevant family history
  • CT chest to investigate CXR abnormality and/or exclude pulmonary embolism
  • Echocardiogram, ECG and BNP to assess for cor pulmonale
  • Sputum culture in cases of chronic productive cough

Differentiating COPD and asthma

Table 2: NICE Guideline. Clinical symptoms that may help differentiate COPD and asthma [4]

Feature COPD Asthma
Smoker or ex-smoker Nearly all Possible
Symptoms aged < 35 years Rare Often
Chronic productive cough Common Uncommon
Breathlessness Persistent and progressive Variable
Night waking with sob/wheeze Uncommon Common
Diurnal or day to day variability of symptoms Uncommon Common
Post a comment

Leave a Comment