Key Indicators for Considering a Diagnosis of COPD
Consider COPD and perform spirometry if any of these indicators are present. These indicators are not diagnostic by themselves, but the presence of multiple key indicators increases the probability of a diagnosis of COPD. Spirometry is needed to establish a diagnosis of COPD
Chronic cough:
- present intermittently or daily
- often present throughout the day; seldom only nocturnal
Chronic sputum production: any pattern of chronic sputum production may indicate COPD
Dyspnea that is:
- progressive (worsens over time)
- persistent (presents every day)
- described by the patient as “increased effort to breathe,” “heaviness,” “air hunger,” or “gasping”
- worse during exercise
- worse during respiratory infections
Family history: A family history can indicate either the presence of an alpha1-antitrypsin deficiency or a set of environmental factors that can contribute to COPD.
Exposure to pollutants/irritants: Continued exposure, either at home or at work, can indicate the presence of COPD. Patients may be asked specific information about the presence of respiratory symptoms (such as coughing, wheezing, dyspnea) following exposure to common, nonspecific stimuli such as smoke, dust, and fog.
Changes in temperature: Patients with COPD often relate exacerbations to climate, particularly extreme variations in temperature and humidity. The effects of high humidity probably relate to the high level of pollution that often accompanies extremely humid weather as well as to the amount of water vapor in the air. Some patients also appear to be abnormally sensitive to the inhalation of cold air.
Age: A patient's age can be an important determining factor in establishing an accurate diagnosis. COPD is generally associated with advanced age, while asthma and asthmatic bronchitis can occur at any age, and generally occurs at a younger age than COPD. Burrows et al, for example, compared the mean ages of patients with asthmatic bronchitis to those with emphysematous COPD. The mean age of those with asthmatic bronchitis was 29.6 years, compared with 64.6 years for patients with COPD. Patients without asthma, but with chronic airflow limitation, were more likely to have an alpha1-antitrypsin deficiency and were, for the most part, between 40 and 50 years of age.
COPD Differential DiagnosisDiagnosis Suggestive Features for Differential Diagnosis of COPD |
DyspneaChronic progressive dyspnea is characteristic of patients with COPD, while episodic dyspnea is more common in asthmatics. Unfortunately, there can be a significant overlap between these 2 types of dyspnea, creating confusion in establishing an accurate diagnosis. |
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