Getting a diagnosis of chronic obstructive pulmonary disease (COPD) may take time and come with uncertainty. COPD is often misdiagnosed or missed altogether until you’ve lost a lot of lung function.

Doctors diagnose COPD with a combination of a detailed medical history, chest X-rays or CT scans, and pulmonary function tests. Your doctor may also take a blood sample to measure the level of oxygen in your blood. Tests will determine whether the symptoms are caused by COPD or another heart or respiratory issue, such as pneumonia, heart disease, asthma, or lung cancer. It’s possible to have COPD and another heart or lung condition at the same time. When diagnosing COPD, your doctor may or may not specify that you have a specific type of COPD.

Who Is Tested for COPD?

Not everyone gets tested for COPD. Testing depends on your symptoms and risk factors. COPD is most commonly diagnosed in people aged 40 or older and becomes more common with age as your lung function declines. Many people think of COPD as a disease caused only by smoking, but smoking is just one of several COPD risk factors. About 25 percent of people diagnosed with COPD have never smoked.

You’re also at risk for COPD if you:

• Had a lot of respiratory infections growing up
• Have asthma
• Have underdeveloped lungs
• Have been exposed to secondhand smoke
• Were exposed to smoke from something other than tobacco, like a wood-burning stove
• Live in an area with heavy air pollution
• Have been exposed to chemical fumes on the job
• Have family members with COPD

Your doctor may ask about these risk factors when checking for COPD.

When To Get Tested for COPD

Your doctor may recommend diagnostic testing for COPD if you have common COPD symptoms or if you’ve been exposed to smoke or other fumes that put you at a high risk.

Long-Term Exposures

Let your doctor know if you’ve been exposed to pollution, dust, chemical fumes, or smoke for long periods of time. Airborne toxins, smoke, and fumes can cause irreversible damage to your lungs, eventually leading to COPD.

An Ongoing Cough

The most common sign of chronic bronchitis, a type of COPD, is a chronic cough, or a cough that lasts for three months or longer. A COPD cough may or may not bring up sputum (mucus). During a diagnostic evaluation for COPD, you should tell your doctor how much you cough, how long you’ve had a cough, and how much mucus (if any) comes up.

Shortness of Breath

Shortness of breath is the most common symptom of emphysema, another type of COPD.

Tell your doctor if you have trouble breathing, especially if your breathing problems make it hard to keep up with other people your age. Shortness of breath during everyday activities that wouldn’t normally cause you to lose your breath can be a sign of COPD and should be evaluated.

Wheezing

If you wheeze or hear other sounds when you breathe, it could be a sign of COPD. During a diagnostic evaluation, your doctor can listen to the wheezing or other lung sounds using a stethoscope.

What Tests Are Done To Diagnose COPD?

During the COPD diagnosis process, your doctor starts by taking a thorough medical history and asking about your COPD symptoms. You’ll also be asked about your family history of lung problems, whether you’ve ever smoked or are currently smoking, and any other health issues, including asthma. Knowing about your personal and family history may help doctors pinpoint which tests to perform.

Your healthcare provider will ask about being around things that can harm your lungs for a long time, such as smoke, chemicals, or toxins, before recommending more testing.

Spirometry

Spirometry is the most common lung function test used to diagnose COPD. During a spirometry test, you’ll breathe into a tube that evaluates lung function by monitoring how much air you’re able to blow.

The device you blow into, called a spirometer, takes two measurements: the amount of air you blow out in the first second, and the amount of air you blow out when you fully empty your lungs. The doctor uses the first measurement to calculate forced expiratory volume, or FEV1. The second measurement determines your forced vital capacity, or the amount of air you exhale in total. The FEV1 helps your doctor tell how much your airflow is obstructed.

Spirometry doesn’t just help doctors diagnose COPD. It can also tell you how severe your COPD is. Based on your spirometry test results, your doctor can tell you what stage of COPD you have, which helps them guide your treatment.

Diffusing Lung Capacity

Diffusing lung capacity (DLCO) is another lung function test your doctor may give you during the same visit as your spirometry test. Instead of measuring your lungs’ capacity for air, it measures how well your lungs exchange oxygen and carbon dioxide (CO2).

Like spirometry, the result of your DLCO test helps your doctor create a treatment plan that will help manage your COPD symptoms effectively.

Peak Expiratory Flow Test

Also often performed during spirometry, a peak expiratory flow test measures how fast you can blow air out of your lungs and into a handheld device. Your peak expiratory flow rate helps you monitor your lung function even after your initial COPD diagnosis and can guide your doctor to make adjustments to your treatment.

Imaging Tests

Chest X-rays and CT scans provide images of the heart, lungs, and blood vessels to determine any damage and signs of COPD versus another disease.

Chest X-Ray

X-rays can help identify whether or not you have emphysema, pneumonia, or other lung conditions. A chest X-ray can’t tell you how well your lungs are working, but it can show lung changes that help your doctor better understand your COPD and conditions that interact with it.

CT Scan

CT scans generally provide more detail than X-rays by making a 3D image of your lungs. They can help rule out lung cancer and show other lung problems, like excess fluid around your lungs.

Oximetry or Arterial Blood Gas Test

Arterial blood gas (ABG) helps assess lung function and lung disease progression. A blood sample is taken from an artery to measure blood oxygen and carbon dioxide levels. ABG results show how capable your lungs are at moving oxygen into your blood and eliminating CO2.

Sputum Examination

By analyzing your sputum (mucus), your doctor can determine whether breathing issues are caused by lung cancer or a bacterial infection rather than COPD. The easiest way to do this is by looking at the color of your phlegm.

Genetic Testing

A blood test for the genetic disorder alpha-1 antitrypsin deficiency (alpha-1) can help determine the cause of COPD. This is especially true if you have family members with COPD who were diagnosed in their 40s or 50s or have liver disease. An alpha-1 deficiency is also a risk factor for liver disease.

People with alpha-1 produce a limited amount of a protein called alpha-1-antitrypsin (AAT), which helps protect the lungs. Alpha-1 can cause a form of emphysema, even without smoking. If you have alpha-1, your doctor may recommend a treatment called augmentation therapy to increase the amount of AAT in your lungs. You get this alongside other COPD treatments like bronchodilators and inhaled corticosteroids to minimize lung damage.

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