Exact criteria for COPD diagnosis

[AlanIn AZ]

Does anyone have details on the exact criteria used by doctors to diagnose COPD?

My doctor diagnosed me with COPD (years ago) but I'm a little skeptical in detail?

I have had a 2 sleep studies and do clearly have sleep Apnea - but it doesn't bother me that much, I do snore and my wife complains about it a lot (she is very sensitive to noise and movement in bed).

I do also suffer from acute pulmonary distress usually brought on by environmental/allergy triggers (smoke, dust & desert allergens). These episodes last 1-2 weeks (sometimes more) and sometime also follow a cold/flu episode. They tend to be seasonal late fall/late winter or due to major weather/climate changes. Allergy panel testing shows I have massive reactions to just about everything in Arizona (I live in Arizona) - surprisingly though most of the time I am fine.

So I use the CPAP machine routinely to keep my wife happy at night, but then I do need it occasionally for me for the acute episodes. Not sure I really have any consistent "Chronic" OPD issues to treat.

The episodic stuff is basically Acute Bronchitis with lots of wheezing & tickly breathing (in & out). I'd like to get a better idea of extent of any potential Emphasema long term damage (how is that best done?). Regular spirometry tests suggest I lost some lung function/volume but not too much and that its generally stable. My ability to climb mountains however seems to be much diminished, so I suspect other things going on too (e.g. volume & functional loss?)

It may be that diagnosing as COPD was just the easiest, least questionable way to trigger CPAP coverage on insurance?

Anyone have more details on the actual diagnosis criteria used?

Alan

[Julie]

The very short answer is that your FEV1 is low as would be FVC as well. That seems to be the main feature, though other symptoms/signs would eventually be seen in time. There's a lot of info on Google, however, probably more and maybe more accurate than our guesses would be... seeing as we're all about OSA and Cpap. Why not go for a second opinion and new testing now? COPD can also happen with or without asthma, allergies, etc. so a definitive lab diagnosis is important. Do you smoke?

[kteague]

Don't have an answer to your question, but in regards to your CPAP use, does your machine have the filters for allergens and are you using them? Just thinking every little bit helps. I have no allergies at night but feel them almost as soon as I take off my mask.

[AlanIn AZ]

The very short answer is that your FEV1 is low as would be FVC as well. That seems to be the main feature, though other symptoms/signs would eventually be seen in time. There's a lot of info on Google, however, probably more and maybe more accurate than our guesses would be... seeing as we're all about OSA and Cpap. Why not go for a second opinion and new testing now? COPD can also happen with or without asthma, allergies, etc. so a definitive lab diagnosis is important. Do you smoke?

I have never smoked (though was exposed to some second hand smoke as a child). I never had any allergy symptoms either until ~15 years after I arrived in Arizona (about 13 years ago now).

The diagnosis interest is mostly just academic since I know what to expect and get other value from daily CPAP use anyway (or my wife does - which to me is ~the same thing).

My FEV1/FVC ratio varies depending if measured during an acute episode Vs at other times. This again suggests to me its more an acute not chronic issue - but my actual effectiveness at oxygenating my blood during any significant excercise is still questionable - certainly much diminished over 10 years ago. So total FEV1% Predicted must be low - need to look up the latest tests and see how much that varies from nornmal to episodic too (not sure I have that data). Seems there are different criteria by regions USA and Europe don't quite agree. But seems I may qualify as COPD via FEV1% Predicted alone (at least while I am in Europe!).

I think I need to investigate previous spirometry results some more. I can't easily characterize the tests though - all were take as a result of acute incidents - but sometimes by the time I got an appointment I was already much improved (but for which ones?). Maybe need to go in when I am feeling perfectly good and get some baseline spirometry done then.

Alan

[AlanIn AZ]

Don't have an answer to your question, but in regards to your CPAP use, does your machine have the filters for allergens and are you using them? Just thinking every little bit helps. I have no allergies at night but feel them almost as soon as I take off my mask.

I do have filters and change them regularly but they aren't specifically HEPA or anything like that. Anyway I don't feel the machine is an issue as I always get relief with it - like with you it's the rest of the day that gets me started.

Alan

[ajack]

cpap doesn't treat any of the copd, asthma and bronchitis can fall within the obstructive, restrictive, hypovent group. You may need to be put onto a bilevel/bipap. I would do this through a pulmo and not a sleep doctor.

[SewTired]

FYI - according to the Mayo Clinic site, COPD is often misdiagnosed. It looks like what they do is a series of tests and if other things are ruled out, then it's COPD. That seems too generalized, but WAS true when my Dad was diagnosed around 2002. I would think they have a better handle on it now though.

http://www.mayoclinic.org/diseases-cond ... c-20204917

[AlanIn AZ]

FYI - according to the Mayo Clinic site, COPD is often misdiagnosed. It looks like what they do is a series of tests and if other things are ruled out, then it's COPD. That seems too generalized, but WAS true when my Dad was diagnosed around 2002. I would think they have a better handle on it now though.

http://www.mayoclinic.org/diseases-cond ... c-20204917

Thanks for the link - that's also a bit how it felt in my case. Plus I think a COPD diagnosis does trigger insurance coverage approvals for CPAP etc which my Dr. said would help with some of my symptoms - and it did. So maybe its an easy and pragmatic step but perhaps not totally justified on technical grounds.

Alan