A person blowing into a spirometer. Smaller handheld devices are available for office use. The diagnosis of<unk>  should be considered in anyone over the age of 35 to 40 who has shortness of breath, a<unk>  cough, sputum production, or frequent winter colds and a history of exposure to risk factors for the disease. Spirometry is then used to confirm the diagnosis. Spirometry Spirometry measures the amount of airflow obstruction present and is generally carried out after the use of a bronchodilator, a medication to open up the airways. Two main components are measured to make the diagnosis, the forced expiratory volume in one second (FEV1), which is the greatest volume of air that can be breathed out in the first second of a breath, and the forced vital capacity (FVC), which is the greatest volume of air that can be breathed out in a single large breath. Normally, 75–80% of the FVC comes out in the first second and a FEV1/FVC ratio less than 70% in someone with symptoms of<unk>  defines a person as having the disease. Based on these measurements, spirometry would lead to over-diagnosis of<unk>  in the elderly. The National Institute for Health and Care Excellence criteria additionally require a FEV1 less than 80% of predicted. People with<unk>  also exhibit a decrease in diffusing capacity of the lung for carbon monoxide due to decreased surface area in the alveoli, as well as damage to the capillary bed. Testing the peak expiratory flow (the maximum speed of expiration), commonly used in asthma diagnosis, is not sufficient for the diagnosis of<unk> . Screening using spirometry in those without symptoms has uncertain effect and is generally not recommended; however, it is recommended for those without symptoms but with a known risk factor. Assessment +MRC shortness of breath scale Grade Activity affected 1 Only strenuous activity 2 Vigorous walking 3 With normal walking 4 After a few minutes of walking 5 With changing clothing +GOLD criteria Severity FEV1 % predicted Mild (GOLD 1) ≥80 Moderate (GOLD 2) 50–79 Severe (GOLD 3) 30–49 Very severe (GOLD 4) File:COPD.alt=A black and white image,Chest X-ray demonstrating severe<unk> : Note the small heart size in comparison to the lungs. File:Barrowchest.A lateral chest X-ray of a person with emphysema: Note the barrel chest and flat diaphragm. File:BullaCXR.Lung bulla as seen on chest X-ray in a person with severe<unk>  Medical X-Ray imaging WFH07 nevit.A severe case of bullous emphysema File:Bullus emphasemaCT.Axial CT image of the lung of a person with end-stage bullous emphysema File:EmphysemaPlusLungCA.Very severe emphysema with lung cancer on the left (CT scan) Differential diagnosis<unk>  may need to be differentiated from other conditions such as congestive heart failure, asthma, bronchiectasis, tuberculosis, obliterative bronchiolitis, and diffuse panbronchiolitis. The distinction between asthma and<unk>  is made on the basis of the symptoms, smoking history, and whether airflow limitation is reversible with bronchodilators at spirometry.<unk>  bronchitis with normal airflow is not classified as<unk> .
Chronic obstructive pulmonary disease
Tracheobronchomalacia
Asthma
Bronchiectasis
Reactive airway disease
Pneumonia
End stage pulmonary disease
Acute bronchitis