Making the Diagnosis of COPD

Undiagnosed COPD

A recent large population-based study, the third National Health and Nutrition Examination Survey (NHANES III), found that a large proportion of patients with COPD have not been diagnosed. This is true despite these patients manifesting symptoms of cough, excess mucus, dyspnea on exertion, or wheeze — the cardinal signs and symptoms of COPD. Even patients with moderate to advanced stages of disease may not be diagnosed, and accordingly, do not receive treatment. Today we have a powerful armamentarium to use for patients found to have early-stage COPD. These therapies can prevent progression into advanced stages of the disease. The catastrophe of developing emphysema with its life threatening implications, the need for oxygen and possibly surgery, and its tremendous impact on healthcare costs, make early diagnosis and intervention imperative.

We now recognize that spirometry is a simple expression of a complex process. Like blood pressure, spirometry has many determinates, as summarized in Table 1.

Who Should be Tested?

A consensus report of the National Lung Health Education Program (NLHEP) Spirometry Committee recommends simple spirometric testing for all smokers age 45 years or older. Testing should also be done in anyone with chronic cough, excess mucus, dyspnea on exertion, or wheeze. These are the major symptoms of COPD, which includes a spectrum of diseases: asthmatic bronchitis, chronic bronchitis, and emphysema. It is the emphysema component of this spectrum that leads to the greatest impairment and disability. In addition, anyone with a family history of emphysema or chronic bronchitis should have a spirometric test as a part of their initial evaluation. Knowing simple lung function values provides a baseline by which subsequent changes can be evaluated.

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