Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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The diagnosis of this respiratory condition is based on a combination of clinical history, physical examination, and objective physiological testing. A clinical diagnosis should be considered in any patient who has dyspnea, chronic cough, or sputum production, and a history of exposure to risk factors. However, the definitive diagnosis requires the demonstration of persistent airflow limitation. At Liv Hospital, we employ a comprehensive diagnostic protocol not only to confirm the disease but also to phenotype the patient’s specific traits, which guides personalized treatment strategies. Early diagnosis is crucial, as early intervention can slow disease progression and preserve lung function.
Spirometry is the most reproducible and objective measurement of airflow limitation and is the gold standard for diagnosis. It is a non-invasive test where the patient blows forcefully into a mouthpiece connected to a machine.
To distinguish this condition from asthma, a reversibility test is often performed. Spirometry is conducted before and after the administration of a short-acting bronchodilator medication. In classic asthma, airflow obstruction is characterized by a significant improvement in FEV1 after medication. In this condition, the obstruction is largely fixed or irreversible. While some patients may show partial improvement, the airflow limitation remains significant. This distinction is essential for determining the primary therapeutic approach, although the boundary between the two conditions can sometimes be blurred in overlap syndromes.
Imaging plays a vital role in the evaluation process, primarily to assess the extent of emphysema and to rule out other lung pathologies.
In patients with severe disease or low pulse oximetry oxygen saturation, an arterial blood gas analysis is performed. This test measures the partial pressure of oxygen and carbon dioxide in the arterial blood, as well as the pH.
The World Health Organization recommends screening all patients with this condition once for alpha-1 antitrypsin deficiency. This is done via a blood test to measure the protein’s level. If levels are low, confirmatory genetic testing is performed. Identifying this genetic cause is critical because it changes the management plan, potentially qualifying the patient for augmentation therapy, and has significant implications for family members who may also carry the gene.
Diagnosis is not just about lung numbers; it is about the impact on the patient’s life. Standardized questionnaires are used to assess symptom burden.
Given the systemic nature of the disease, a thorough evaluation includes screening for common comorbidities.
Tests like the 6 minute walk test are used to evaluate functional exercise capacity. This test measures the distance a patient can walk in six minutes on a hard, flat surface. It provides an integrated assessment of the pulmonary, cardiovascular, and muscular systems. Desaturation during the walk can identify patients who need supplemental oxygen during activity. It also serves as a baseline to measure the effectiveness of pulmonary rehabilitation programs.
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Blowing into the tube measures how much air you can move and how quickly, which helps doctors determine whether your airways are narrowed and confirms the diagnosis.
FEV1 stands for Forced Expiratory Volume in one second; it measures how much air you can push out in the first second of a breath, indicating the severity of the blockage.
A CT scan provides much more detailed cross-sectional images of the lungs, allowing doctors to see early emphysema or airway changes that a regular X-ray might miss.
The test involves taking blood from an artery in the wrist, which can be slightly more uncomfortable than a regular vein blood draw. Still, it provides critical information about oxygen levels.
Even in smokers, a genetic deficiency can make the lungs much more sensitive to damage, causing the disease to develop faster and more severely than expected.
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