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Chronic Obstructive Pulmonary Disease Diagnosis

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This information was reviewed and approved by Russell P. Bowler, MD, PhD, Irina Petrache, MD (2/28/2021).

The first step in a COPD diagnosis is a thorough evaluation by an experienced doctor. A specialist who often sees people with COPD is a pulmonologist.

Your doctor will conduct a complete physical exam and ask you questions about your lifestyle, including your family, your job, your habits, your hobbies, your current medications and your symptoms.

Your doctor may have you do a number of tests to evaluate your breathing, lungs and other aspects of your health. There are other diseases and disorders that may be confused with COPD, but also may be seen with COPD and lead to a COPD diagnosis. These tests will help determine the right diagnosis and the best treatment plan for you.

Breathing, Exercise, and Oxygen Tests

A battery of pulmonary function tests measures how well you are breathing. There are different types of breathing tests that can be done in a pulmonary function testing lab under the coaching of a technician, using specialized equipment. The results of pulmonary function testing can help your doctor find the best treatment plan for you and monitor the progression of COPD.

  • Spirometry: A spirometry test measures airflow in and out of the lungs. This indicates whether or not there is airway narrowing that obstructs the flow of air in and out of the lungs. Spirometry test results are useful in making the diagnosis of a class of lung disorders. Even more important, yearly spirometry measurements help to detect lung disease at an early stage when lifestyle changes and treatment may help forestall future problems.

  • Complete pulmonary function tests: Pulmonary function tests provide a more in-depth measure how well you are breathing, as it combines spirometry with measurements of lung volumes and ability of the lung to transfer inhaled gases from the air into the bloodstream. The results of pulmonary function testing can help your doctor find out more about the kind of COPD you have and how severe it is.

  • Pulse oximetry: Pulse oximetry can measure the oxygen level in your finger. It can be done when you are resting, walking, and sleeping. This test evaluates if you may benefit from supplemental oxygen at rest or during exercise. If the oxygen gets low during sleep, you may be referred for a more detailed sleep testing.

  • Exercise tolerance testing: The exercise tolerance test evaluates the level of activity you can perform. It also evaluates your oxygen needs when you exercise and how your lungs and heart are responding to exercise. The results of the test can help our doctor determine why you experience shortness of breath during exercise.

  • Exercise for desaturation testing: The exercise for desaturation test evaluates if you may benefit from supplemental oxygen at rest and during exercise.

  • Arterial blood gas testing: Arterial blood gas is a blood sample test ordered by your physician to evaluate measurements of oxygen level, carbon dioxide (effectiveness of respiration), and several other parameters. Generally, it is indicated when your physician needs to evaluate the effectiveness of your breathing.

  • Bronchial provocation test: The bronchial provocation test evaluates how sensitive the airways in your lungs are. A spirometry breathing test is done before and after you inhale a spray such as methacholine. The spirometry results are compared before and after you inhale the spray to see what changes there are in your breathing.


X-Rays and CT (CAT) Scans

  • X-rays: X-rays can show irregularities or damage in the lungs caused by COPD and other acute and chronic lung diseases.

  • CT scan of the chest: A CT or CAT scan is a shortened name for computerized tomography. During a CT scan of the chest detailed pictures are taken of cross sections or slices of the thoracic structures in your body. Thoracic structures include your lungs, heart and the bones around these areas. Sometimes intravenous contrast is administered to better see the blood vessels in the lung.

  • Lung cancer screening: Lung cancer screening looks for lung cancer before you have symptoms. If you are at high risk for this disease, you doctor may recommend  lung cancer screening.


Other Tests

You doctor may verify a diagnosis, or evaluate what other diseases or conditions may be present with other tests (for each test link to test facts information).

  • EKG: An electrocardiogram (ECG or EKG) checks for an abnormal heart rhythm.

  • Echocardiogram: An echocardiogram is an ultrasound of the heart. The ultrasound shows the structures and functions of the heart muscle and heart valves from different angles. It does this by using sound waves.

  • Cardiac stress test: Medicine or exercise may be used during a cardiac stress test. Either will temporarily increase your heart rate and/or open up (dilate) the heart arteries. This test may show evidence of blockages in the heart arteries when the heart is stressed.

  • Abdominal ultrasound: An abdominal ultrasound (sound waves) can be used to look at organs, soft tissue and blood vessels within the abdomen.

  • Bone scan: A bone scan is a test that can identify bone that is diseased or injured. Normally, bone absorbs nutrients that are the building blocks of bone formation. If bone is diseased or injured, nutrients are absorbed differently. The bone scan takes pictures of this process. A bone scan can pick up on bone disease or injury that may not be seen with a traditional x-ray.

  • pH impedance study: A pH impedance study measures the amount of gastroesophageal reflux you have. Gastroesophageal reflux is the backward flow or reflux of food and acid from the stomach into the esophagus. The esophagus is the tube that takes food from your mouth into your stomach. A pH impedance study will help identify if you have increased amounts of reflux and if it is causing you to have more exacerbations or flare-ups of your COPD.

  • Mucus culture: Some kinds of bacteria like to live in the mucus produced in the sinuses and airways of the lungs. A culture of this mucus can help identify an infection. Lung and/or sinus infections can complicate and/or mimic some symptoms of COPD.

  • Bronchoscopy: A bronchoscopy allows the doctor to look inside the airways in the lungs. The bronchoscopy can be videotaped to look at later. Your doctor may also do a lavage, which involves putting a small amount of fluid into the airways, and the fluid is then pulled out with cells from the airways of your lungs. A biopsy of the airway may also be done, where a small amount of the tissue is taken from the lining of the lung. The cells and tissue can be studied closely to help determine your diagnosis and the best treatment for you.

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