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Although COPD is a common condition, many people remain undiagnosed. Symptoms often develop gradually, and people may not realise they have the disease until it has reached a more advanced stage. This delay in diagnosis is frequently due to the slow progression of symptoms, which are sometimes attributed to aging or long-term smoking. Some people may also hesitate to seek medical help because they feel guilty about smoking. Another reason could be that the GP does not initially link the symptoms to COPD, as they can resemble those of other conditions. As a result, spirometry — which is essential for confirming COPD — may be postponed, further delaying diagnosis.
Knowing the early warning signs of COPD is important, especially if you’re at higher risk of developing COPD (see our module on Symptoms). The earlier COPD is diagnosed, the sooner treatment can begin, which will help slow down lung damage. If you notice any symptoms, talk to your healthcare provider. On this page, you’ll learn how COPD is diagnosed, what tests may be used for diagnosis, and how COPD is classified into different stages.
To diagnose COPD, your healthcare provider will ask you a range of questions, perform a physical exam, and offer specific tests to diagnose the condition. Depending on the availability of the materials in their office, your provider might also refer you to a specialist for further testing.
Your GP may ask you questions such as:
To feel optimally prepared for your first consultation, check out our PDF guide here.
If your doctor thinks you might have COPD, a few tests might be proposed, which can be broadly divided into three big groups: lung function tests, imaging, and lab tests.
Your provider will probably also explore whether you also have one or more other diseases that frequently occur alongside COPD. This can be done by asking you specific questions and by performing or ordering additional tests. These may include blood pressure measurements, an electrocardiogram (ECG), blood sugar testing, or screening for conditions such as anxiety, depression, or osteoporosis (weak or brittle bones).
To better understand how your symptoms affect your daily life, your healthcare provider may ask you to complete one or more questionnaires. For COPD, the most commonly used tools are the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) dyspnea scale. The CAT helps evaluate how much COPD impacts your day-to-day activities and overall well-being, while the mMRC scale is used to assess the degree of breathlessness during daily activities.
Unfortunately, COPD is a progressive disease, which means it worsens over time. The rate of progression, however, can vary greatly from person to person.
Spirometry, which is a type of lung function test, is used to diagnose COPD, but it is also used for follow-up of the disease progression. With spirometry, the amount of air you can blow out in a single forced breath is measured. The amount of air you can blow out in one second (FEV1) compared to normal values (how much you should be able to blow out) is described as the level of airflow obstruction. These values are used to stage COPD.
|
COPD stage
|
Meaning
|
Your FEV1 value*
|
|---|---|---|
|
Stage 1
|
Mild airflow obstruction
|
≥ 80% predicted
|
|
Stage 2
|
Moderate airflow obstruction
|
Between 50 – 80 % predicted
|
|
Stage 3
|
Severe airflow obstruction
|
Between 50 – 80 % predicted
|
|
Stage 4
|
Very severe airflow obstruction
|
< 30 % predicted
|
* The value used by doctors to see how well your lungs are working. It measures how much air you can blow out in the first second of a strong, fast breath after taking a deep inhale
It is important to keep in mind that airflow obstruction is only part of how the severity of the disease is measured. In the past, doctors relied mainly on lung function tests to help decide what treatments could work for you, but your symptoms don’t always match the level of airflow limitation. For this reason, COPD is no longer classified by lung function results alone. The new classification system also considers how many symptoms you have, how breathlessness affects your daily life, and your risk of flare-ups (exacerbations). This combined approach helps doctors choose the most suitable treatment from the start and puts greater emphasis on preventing future flare-ups.
Other factors that can make your COPD more severe are your overall level of fitness, the presence of other medication conditions, and smoking.
People with severe COPD usually have more pronounced symptoms. They are more likely to be breathless or troubled by coughing or excessive phlegm. In the later stages of COPD, you might also develop other more general symptoms, like fatigue, weight loss or swollen feet or ankles (oedema).
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