Chronic obstructive pulmonary disease is an umbrella term for several progressive lung conditions that limit the airflow and makes breathing an increasing challenge. Smoking is the most common cause in the developed world, but exposure to other irritants, whether at home, in the workplace, or even in the form of air pollution, can also contribute.
The first symptoms of COPD are usually (fairly mild) shortness of breath, a persistent cough, wheezing, and a feeling of tightness in the chest. Patients often initially wave these symptoms off as signs of aging, a random respiratory infection, or even a general "smoker's cough", without being too worried about seeking medical attention. When their symptoms don't go away and instead become more intense, however, they'll eventually end up in the doctor's office.
Questions your doctor will ask you as they figure out whether you could have COPD
Doctors can use a tool called the COPD Diagnostic Questionnaire (CDQ) to determine whether people who have a known history of smoking but who don't have another respiratory diagnosis are at risk of chronic obstructive pulmonary disease. Since known smokers don't need to be asked whether they smoke or have done so, that question isn't part of the questionnaire — but if your doctor doesn't know whether or not you smoke or are a former smoker, that will certainly be among the questions they ask.
So, here's the CDQ:
- How old are you? (The older you are, the higher your score, which is added to a total that gives your doctor an idea of how likely you might be to have COPD.)
- How long have you smoked, in years in total? (The more years, the higher the score.)
- How many cigarettes do you smoke per day, or did you smoke when you were a smoker? (You get the idea — the more you've smoked, the higher your risk.)
- Your doctor will ask you how much you weigh and how tall you are, or will weigh and measure you. This is to calculate your body mass index. A higher BMI yields a lower score in this case, with people who suffer from COPD being more likely to tend towards the lower end of the BMI scale.
- Do weather conditions affect your cough? (Answering "yes" indicates a higher risk of COPD.)
- Do you ever cough up phlegm when you do not have a cold? (An affirmative answer indicates a higher risk of COPD.)
- Do you usually cough up phlegm when you first wake up in the morning? (This, the dreaded smokers' cough, represents a risk.)
- How often do you experience wheezing? (Never makes for a low score, frequently denotes a high score.)
- Do you have any allergies?
Your doctor may also want to know if:
- You have been exposed to workplace irritants that could cause COPD, and if so, for which ones and for how long.
- You live in a low or middle income country, how you cook and heat in your home. Biofuel methods can increase your risk of COPD.
- You have a history of respiratory infections, especially during childhood.
- How long have you experienced these symptoms?
- You are often short of breath, and under what circumstances — such as during exercise or at rest.
- Your physical position (standing up vs lying down, for instance) impacts the severity of your symptoms.
- Spirometry. This test measures how much air you can breathe out in one second, as well as in one complete breath. It is performed after you are given a bronchodilator (medication) to open your airways and will be repeated a few times to make sure the measurements are representative. Your doctor can then determine if your lung function is normal or restricted.
- Chest and lung x-rays. This will look for other lung conditions that cause symptoms akin to those of COPD, including lung cancer and infections (though x-rays cannot diagnose these with certainty).
- Blood tests to rule other conditions out, and sometimes to test for an alpha-1-antitrypsin deficiency. This is a genetic problem that significantly raises a person's risk of COPD.
- An analysis of your phlegm. This is useful to determine whether you have an infection.
- A peak flow test, which can help your doctor differentiate between COPD and asthma.
- A CT scan, which can show lung problems more clearly.
- Heart function tests like an electrocardiogram and an echocardiogram.