Symptoms and diagnosis of COPD

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In spite the well-known risk factors, the majority of COPD patients (up to 70%) remain undiagnosed. In the early phases, patients may cough with sputum production but may not be physically active enough for their shortness of breath to become evident. It is only by a regular measurement of lung functions in patients at risk, that the disease will be unmasked in its early stages. Patients at risk should request that their doctors do lung function measurements, which include the forced expiratory volume in one second (FEV1), vital capacity (VC) and the FEV1/VC ratio. It is only when lung function deteriorates to a measured FEV1 of less than 50% of the predicted value that patients experience severe enough symptoms to report their respiratory impairment. The importance of early diagnosis is that preventative measures, including avoidance of risk factors, can be instituted. This will have major long-term benefits for affected individuals. A diagnosis of COPD should be considered in any patient who has a chronic cough, sputum production, shortness of breath and/or history of exposure to risk factors. The diagnosis is confirmed by lung function testing. Disease symptoms are frequently initiated by a severe attack of bronchitis, usually during the wintertime when influenza and colds are endemic. These patients commonly complain of an irritating persistent cough accompanied by sputum production or a wheeze. Smokers usually have a much longer recovery time than non-smokers and experience more severe symptoms during acute exacerbations of COPD. In patients with severe respiratory impairment, these attacks may lead to respiratory failure. Oxygenation becomes so limited that a blue tongue and lips indicate severe impairment of oxygen uptake. Acute exacerbations may also be accompanied by evidence of failure of the right ventricle to pump adequately due to increased pressure in the vascular bed of the lungs, which is characterised by swollen ankles and legs, an enlarged liver and elevated neck veins. Symptoms of respiratory and right heart failure usually justify admission to hospital. Active treatment of these conditions can reverse the heart or lung failure, while identification of factors that cause exacerbation e.g. respiratory infections; fluid overload or lung clots should be remedied, thereby preventing further acute incidents.