Fast Five Quiz: Differential Diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

Zab Mosenifar, MD


February 04, 2022

Chest radiography of patients with COPD tends to reveal signs of severe hyperinflation, including possible flattening of the diaphragm, increased retrosternal air space, and a long, narrow heart shadow. Other signs or changes that may show up on chest radiographs include increased bronchovascular markings, cardiomegaly, and hyperlucency of the lungs.

COPD is characterized by compromised lung function at baseline, as measured by spirometry. Increased frequency and severity of exacerbations continue to diminish lung function over time, but unlike patients with asthma, patients with COPD do not experience periods of normal lung function.

COPD symptoms do not improve spontaneously or have immediate improvement. Instead, management of disease is focused on optimizing pulmonary function and reducing the frequency and severity of exacerbations. Historically, inhaled long-acting beta2 agonists have been used as first-line therapy, along with inhaled long-acting anticholinergics as adjunct therapy, which do not provide immediate results but rather long-term improvement of pulmonary function.

In most patients with asthma, chest radiograph findings are normal. Chest radiography is used primarily as a tool in the initial diagnosis of asthma and to rule out alternative causes and complications.

Learn more about the workup for COPD.


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