Comprehensive history taking for evaluation: When diagnosing COPD, a comprehensive history should first be taken, including symptoms, past history and systematic review, and exposure history.
Diagnosis: The diagnosis of COPD should be determined based on a comprehensive analysis of clinical manifestations, history of risk factor exposure, physical signs and laboratory tests and other information. The main symptoms considered for COPD are chronic cough, sputum and/or dyspnea and history of risk factor exposure; the presence of incomplete reversible airflow limitation is a necessary condition for the diagnosis of COPD. Pulmonary function measurement index is the gold standard for the diagnosis of COPD. Incomplete reversible airflow limitation can be determined with FEV1/FVC <70% after bronchodilators, and early COPD with mild airflow limitation may or may not have clinical symptoms. Chest X-ray is useful to determine the degree of lung hyperinflation and to differentiate it from other lung diseases.
Differential diagnosis
Differential diagnosis of chronic obstructive pulmonary disease
Diagnosis
Differential diagnosis points
Chronic obstructive pulmonary disease
Middle-aged onset; slow progression of symptoms; long history of smoking; shortness of breath after activity; mostly irreversible airflow limitation.
Bronchial asthma
Early onset (usually in childhood); rapid daily symptom variation; nocturnal and early morning symptoms; may also have a history of allergic rhinitis and/or eczema; family history of asthma; airflow limitation mostly reversible.
Congestive heart failure
Fine rales can be heard at the base of the lungs on auscultation; chest x-ray shows an enlarged heart and pulmonary edema; pulmonary function tests show restrictive ventilation impairment (not airflow limitation.)
Bronchiectasis
Large amount of purulent sputum; often accompanied by bacterial infection; coarse wet rales, pestle finger; X-ray chest film or CT shows bronchial dilatation and wall thickening.
Tuberculosis
All ages; X-rays show infiltrative lung lesions or nodular cavity-like changes; bacteriological examination confirms the diagnosis.
Occlusive bronchiectasis
Younger age of onset and non-smoker; may have history of rheumatoid arthritis or smoke exposure, CT film shows hypointense shadow in expiratory phase.
Diffuse panbronchiolitis
Mostly male nonsmokers; almost all patients have chronic sinusitis; radiographs and high-resolution CT show diffuse lobular central nodular shadow and hyperinflation sign.