What to Expect at a COPD History and Physical

How Doctors Diagnose COPD During an Office Visit

COPD history and physical exam
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A COPD diagnosis starts with a thorough history and physical. Combined, they help your doctor confirm, or rule out, a diagnosis of chronic obstructive pulmonary disease (COPD).

Your Medical History

When taking a medical history, your doctor will include questions that relate to the following areas:

  • Family history of lung disease: More and more, research is showing a genetic link to COPD. This is particularly true with Alpha-1-antitrypsin deficiency, a genetic disorder caused by the lack of Alpha-1-antitrypsin, a protective protein made by the liver. People with Alpha-1-antitrypsin deficiency are at higher risk for emphysema, especially if they smoke.
  • A history of childhood respiratory illnesses: According to the Global Initiative for Obstructive Lung Disease (GOLD,) having a history of respiratory illness during childhood may be a risk factor for the development of COPD in adulthood.
  • Current and previous exposure to airway irritants: While cigarette smoking is the number one cause of COPD, long-term exposure to second-hand smoke, indoor and outdoor air pollution and workplace exposure to chemicals, dust and fumes also increase your risk.
  • Smoking history: If you are a current or former smoker, your doctor will want to know when you first started, how many cigarettes you smoke or smoked per day, and -- if you are still smoking --- whether or not you are willing to quit. If you are a former smoker, along with your smoking history, your doctor will also want to know when you quit.
  • Other medical conditions you may have: COPD is associated with many other medical conditions, which doctors call comorbidities. In fact, the impact that the disease has on your life is dependent upon, in part, the co-morbid conditions associated with your disease.
  • Name and dosage of your current medications: Your doctor will want to know any medications you are currently using, including any inhalers as well as any nutritional supplements or vitamins.

Your Symptoms

Once your history has been obtained, your doctor will also want to know about your current symptoms:

  • Shortness of breath: Shortness of breath is the hallmark symptom of COPD. In fact, it is often the first symptom that people notice and seek medical attention for. Your doctor will ask you questions about your shortness of breath that may include when you first noticed it when you experience it the most (during activity or at rest,) how often during the day you are short of breath, and how far you can walk or climb stairs before becoming short of breath.
  • Cough: A long-term cough is yet another symptom of COPD that often prompts a visit to the doctor. If you are experiencing a cough, do you cough frequently throughout the day, or only a few times a week? How long have you been coughing? Is it getting worse? What, if anything, makes you cough more frequently?  Have you considered your cough a smoker's cough?
  • Mucus production: Many people with COPD cough up phlegm or mucus. If you cough up mucus, how much and how often do you do so? What color is your mucus? Is it thick or thin? Has there been a recent change in its color or consistency? Has it gotten worse recently? Have you ever coughed up blood, and if so, how much? Does your mucus have a foul odor?

The Physical Examination

Before a COPD diagnosis can be made, your doctor will perform a complete head-to-toe physical examination that will provide clues as to the reason for your symptoms.

This may involve:

  • Assessing your vital signs, including your temperature, height, weight, body mass index (BMI), blood pressure and pulse.
  • Examining your eyes, ears, nose and throat for redness, swelling, and/or drainage -- each a sign of active infection.
  • Listening to the sounds of your heart and lungs with a stethoscope.
  • Examining your neck veins for evidence of bulging. This could point toward a heart condition known as cor pulmonale, a common complication of COPD.
  • Palpating (gently pressing) and tapping on your abdomen to evaluate for swelling and/or tenderness.
  • Looking at your fingertips, earlobes, and lips for evidence of cyanosis, a bluish discoloration of the skin indicative of long-term oxygen deprivation.
  • Inspecting your nail beds for clubbing, another sign of long-term oxygen deprivation. Clubbing does not occur in COPD alone, but rather when another lung condition is also present, such as high pressure in your lung vessels.
  • Examining your extremities for swelling, also known as edema. Edema is not a direct result of COPD but could be caused by some of the medications you take or other COPD complications.

Once your history and physical are complete, your doctor will then run some diagnostic tests to further evaluate your condition.


American Thoracic Society. Clinical Assessment. Updated February 2015. http://www.thoracic.org/copd-guidelines/for-health-professionals/clinical-assessment-testing-and-differential-diagnosis/clinical-assessment.php

Han, M., Dransfield, M., and F. Martinez. Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging. UpToDate. Updated 09/29/15. http://www.uptodate.com/contents/chronic-obstructive-pulmonary-disease-definition-clinical-manifestations-diagnosis-and-staging

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