Diagnosing COPD Using Better Understood Risk Factors

Chronic obstructive pulmonary disease (COPD) may begin onset with only mild symptoms, and therefore diagnostic techniques must improve, according to research published in the German Medical Association weekly journal Deutsches Arzteblatt International.

Researchers from Oldenburg, Germany reviewed relevant literature surrounding German COPD patients in order to determine the timeline of COPD diagnosis. About a third of all patients already have experienced severe airway obstruction by the time COPD is diagnosed. The researchers combed databases and textbooks for relevant studies on the diagnosis of COPD and current clinical guidelines. Through their search, the investigators determined there were essentially no controlled studies on the diagnostic evaluation of COPD, so those elements were excluded.

Overall, the investigators determined that diagnostic levels of COPD are poor and while the symptoms of COPD are present, clinicians are not considering them indicative of a positive test for the disease. The findings demonstrated that age and smoking status were the 2 biggest criteria in COPD status. One study done in 2005 purported that COPD prevalence was twice as high in men than women and rose with both age and quantity of cigarette smoking. Another study conducted in 2007 found that half of patients discovered to have COPD were not previously diagnosed with the disease.

This literature review indicated risk factors for COPD for non smokers include asthma, advanced age, low educational level, occupational exposure to noxious agents, and a history of airway infections in childhood. Non smokers with COPD generally have a more favorable course of disease progression. The role of air pollution on COPD diagnosis is so far unclear, according to the researchers.

The general symptoms and signs of COPD include dyspnea, chronic cough, low exercise capacity, audible wheezing, more frequent or longer lasting bronchial infections, and sometimes weight loss. The presence of these symptoms in combination with at least 1 risk factor, usually smoking, should give the physician reason to suspect COPD in the patient, the investigators wrote.

Clinicians must also bear in mind that symptoms may have more than one cause, such as coexistent asthma and COPD, lung cancer and COPD, or left heart failure and COPD. These comorbidities can be tested through exercise testing and other forms of testing beyond typical COPD diagnosing methods.

The researchers believe that with the widespread availability of spirometers in primary care physicians’ practices will provide a good basis for improving COPD diagnostic in the future.

“This will be possible only if physicians are watchful for the risk factors for COPD and its mild initial symptoms and perform pulmonary function testing on all patients with a chronic cough, with or without expectoration,” the authors concluded. “The demonstration of an irreversible airway obstruction confirms the diagnosis. Treatment should then be provided as recommended in the pertinent guidelines.”