Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient with chronic bronchitis, which is a symptom that can indicate chronic obstructive pulmonary disease (COPD), the diagnosis of COPD is suspected based on symptoms and signs, and supported by spirometry NICE NG115.
Key investigations recommended to assess for COPD include:
- Spirometry: Post-bronchodilator spirometry should be performed to confirm the diagnosis of COPD NICE NG115. Spirometry is performed at diagnosis, to reconsider the diagnosis for people with an exceptionally good response to treatment, and to monitor disease progression NICE NG115.
- Chest Radiograph: A chest radiograph should be obtained at the time of initial diagnostic evaluation to exclude other pathologies NICE NG115.
- Full Blood Count (FBC): An FBC should be performed to identify anaemia or polycythaemia NICE NG115.
- Body Mass Index (BMI) Calculation: BMI should be calculated as part of the initial diagnostic evaluation NICE NG115.
Additional investigations may be performed when needed, based on clinical findings:
- Sputum Culture: This is used to identify organisms if sputum is persistently present and purulent NICE NG115.
- Serial Home Peak Flow Measurements: These can be used to help exclude asthma if diagnostic doubt remains NICE NG115.
- ECG and Serum Natriuretic Peptides: These assess cardiac status if cardiac disease or pulmonary hypertension are suspected NICE NG115.
- Echocardiogram: This also assesses cardiac status if cardiac disease or pulmonary hypertension are suspected NICE NG115.
- CT Scan of the Thorax: A CT scan may be used to investigate symptoms disproportionate to spirometric impairment, signs suggesting another lung diagnosis (such as fibrosis or bronchiectasis), abnormalities on a chest X-ray, or to assess suitability for lung volume reduction procedures NICE NG115.
- Serum Alpha-1 Antitrypsin: This is assessed for alpha-1 antitrypsin deficiency if there is early onset COPD, a minimal smoking history, or a family history NICE NG115.
- Transfer Factor for Carbon Monoxide (TLCO): This investigates symptoms disproportionate to spirometric impairment or assesses suitability for lung volume reduction procedures NICE NG115.