Dear Dr. Roach: What signs and/or symptoms do you need for a doctor to determine you have chronic obstructive pulmonary disease (COPD)? — R.K.
Answer: The diagnosis of COPD is suspected in people who are at risk for the disease and note one of two cardinal symptoms: cough or dyspnea. (A “symptom” is what a patient identifies by history, while a “sign” is noted on a physical exam. Cough can be both a symptom and a sign.) Dyspnea is usually described as shortness of breath, a sensation that a person can’t get enough air, like they have just run very fast. Some people with COPD may have very subtle symptoms.
Smoking is the biggest risk factor for COPD, but there are other causes, including other chemical exposures (industrial exposures and home cooking fires are less common now, but are historically important causes of COPD); scarring lung disease; and a genetic cause, a condition called alpha-1 antitrypsin deficiency.
The diagnosis is confirmed most often by tests of lung function, which are breathing tests to look at the physiology of the lung and its ability to exchange oxygen and carbon dioxide. Sometimes, the diagnosis can be supported by an X-ray or CT scan, but pulmonary function testing is the best way to determine the severity of COPD and follow the course.
We do have ways of slowing down lung decline in COPD, one way being smoking cessation for current smokers, but some of the medications we use also help reduce ongoing damage.
