Common Symptoms of COPD and How It’s Diagnosed

That’s because symptoms of COPD can be very gradual and subtle, with harmful effects, according to Norman Edelman, MD, a professor of medicine at Stony Brook Medicine in Stony Brook, New York. “People may not know that they have a problem with breathing until they’ve lost a significant amount of their lung function,” says Dr. Edelman.

What Are Common COPD Symptoms?

“It can be very subtle. Someone may notice that they can’t keep up with their friends on the golf course or they get short of breath walking up the stairs when they used to have no problem,” he says.

If the individual is still smoking or if they have chronic bronchitis as part of their COPD, they may have a chronic cough (also known as smoker’s cough) as well, adds Edelman.

• Wheezing: This is breathing that comes with a raspy, whistling, or rattling sound.
• Chest tightness: This can feel like something is squeezing your chest, and you can’t get enough air in.
• Constant fatigue: This feeling of always being tired often results from the decreased muscle strength associated with a long-term inability to exercise.
• Frequent respiratory infections: COPD can increase your risk of developing other respiratory infections, including?acute bronchitis and?pneumonia.
• Cyanosis: This is a blueness of the lips and fingernail beds, which develops from tissues not getting an adequate amount of oxygen.
• Barrel chest: This is an alteration in the shape of the chest, because of the lungs being chronically overinflated with air (in emphysema).
• Reduced appetite and weight loss: People may see a reduction in their appetite which can lead to weight loss. This may be related to the inflammation that occurs in COPD. Increased energy required to breathe may also contribute to weight loss.
• Insomnia: Insomnia is the chronic inability to fall asleep and stay asleep. Studies suggest almost 33 percent of people with COPD have insomnia.

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• Swollen ankles, feet, or legs: This is often secondary to low oxygen levels and can signal more severe COPD.

People with COPD often experience exacerbations as well. These are periods of time when symptoms flare up.

“An exacerbation is when a chronic disease gets worse for some reason. With COPD, this is usually because of infection,” says Richard Castriotta, MD, a professor of clinical medicine at Keck School of Medicine of University of Southern California in Los Angeles. Exacerbations can also occur when environmental air pollution increases, he adds.

How Is COPD Diagnosed?

There are several ways a doctor may work to determine whether you have COPD. Diagnosis focuses on distinguishing your symptoms from other chronic respiratory conditions, such as asthma. A doctor will ask you about your symptoms, perform a physical exam, and may also conduct certain lung function tests.

Health History and Family History

In addition to assessing your symptoms, your physician will want to know about other factors in your history that may make COPD more likely.

• Smoking: This?is by far the greatest risk factor for COPD. About 80 to 85 percent of people with COPD have smoked cigarettes for a significant amount of time, says Edelman. Smoking is the most common?cause of COPD, accounting for as many as 8 out of 10 COPD-related deaths.

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• Lung irritants: This includes air pollution, airborne toxins, or chemical fumes. They can increase the risk of COPD, says Edelman. Certain occupations that involve long-term dust inhalation may be a cause of COPD as well.
• Family history of COPD: Doctors may want to understand if there is a history of COPD in the family for several reasons. One example is an alpha-1 antitrypsin (AAT) deficiency, which is a genetic disorder that can increase the risk of COPD and other diseases.

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• Persistent asthma and allergies: These are important risk factors for COPD, says Edelman. “Even people who haven’t smoked, if they’ve had asthma for a long time, it may change from asthma to COPD,” he says.

Lung Function Tests and Physical Examination

A physical exam is important to inspect the function of your lungs and heart, and look for other visible signs of COPD. Physical signs may include cyanosis (blueness of the lips and fingernail beds). “We can frequently hear the air obstruction when we listen to the chest,” says Edelman. Your doctor may also ask you to blow into a device called a peak flow meter to assess your ability to exhale quickly and forcefully.

Lung function tests could include the following:

• Spirometry:?This involves blowing into a tube connected to a spirometer, a machine that measures the airflow into and out of the lungs. This is the standard respiratory function test used for the detection of COPD, and it is frequently the only test needed to diagnose the condition.

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  “Technically, we can’t make a diagnosis of COPD unless there’s a certain degree of obstruction on a breathing test after the use of bronchodilators,” says Edelman.
• Bronchodilator test: This is a method for measuring the changes in lung capacity after inhaling a short-acting beta agonist that dilates the airway. When an obstructive defect is detected, this test helps to diagnose and evaluate asthma and COPD by measuring reversibility with the use of an inhaled bronchodilator.

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• Lung volume test: This procedure is similar to spirometry and is the most accurate way to measure how much air your lungs can hold.

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• Lung diffusion capacity: This test is used to assess how well the lungs exchange gasses. This is important as a major function of the lungs is to allow oxygen to pass into the blood from the lungs, and to allow carbon dioxide to diffuse from the blood into the lungs.

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• Pulse oximetry: This test can measure the oxygen levels of the blood. It’s performed with a device that clips on a body part such as your finger or your ear. It can be used to check the blood oxygen level of people with COPD.

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Other Tests for COPD

Your doctor might also order?blood tests?and imaging scans, such as:

• Arterial blood gas test:?This evaluates your lungs’ gas exchange capabilities by measuring the precise amounts of oxygen and carbon dioxide in your blood.

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• AAT deficiency test: An AAT deficiency is a potential cause of COPD. The way to determine if someone has an AAT deficiency is through a blood test.

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• Chest X-rays: X-rays?are used to look for lung enlargement, bronchial scarring, and the formation of air-filled cavities in the lungs called bullae.

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• Computerized tomography (CT) scans:?This test provides pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. It is a reliable way to determine the extent of emphysema in your lungs. A CT scan can also help determine whether another condition, such as heart failure or another kind of lung disease is causing the symptoms.

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Once you have a proper diagnosis, you can begin treatment to slow the progression of COPD and relieve symptoms.

The Difference Between Asthma and COPD

COPD is almost always associated with smoking, while asthma can occur in both smokers and nonsmokers.

In asthma, when the airways tighten and you take medication, the airways usually go back to normal, says Edelman. “In COPD, even though medication may relieve the airway tightening, they never quite go back to normal; the airways have changed in structure enough that you can’t open them up fully,” he says.

The Takeaway

COPD has several typical symptoms, such as wheezing, tightness of the chest, and fatigue. Other symptoms may include frequent respiratory infections, insomnia, barrel chest, and in severe cases, swelling of the legs, feet, and ankles.

There are several ways in which a doctor can diagnose COPD. The key components to the diagnosis include risk factors (such as smoking), respiratory symptoms and air-flow obstruction on lung function test. Other information that can be helpful to the doctor includes information about personal health histories, family history of COPD, and a physical exam.

If you are concerned you may be experiencing symptoms of COPD, don’t hesitate to get in touch with a healthcare provider, who will be able to help you understand your symptoms and get the best treatment possible.