There is no single test that can distinguish between Asthma and COPD, but a number of tests that are strongly suggestive of but not specific. For example: 1) pulmonary function testing that shows marked improvement following the administration of an inhaled bronchodilator drug. 2) pulmonary function test change in response to a specific inhalant (methacholine challenge) suggestive but not specific for asthma. 3) CT scanning comes the closest to being that single test when it shows evidence of emphysema. And there are others.
Given the importance, to you and your husband (health and insurance), of establishing the correct diagnosis the best advice I can give you is to request consultation with a recognized expert in the diagnosis of asthma and COPD, preferably with a specialist at a Medical Center with a national reputation; one who has conducted research and treated individuals with both diseases. Such specialist are to be found at many institutions including: The University of Pittsburgh, National Jewish Health in Denver, The Mayo and Cleveland Clinics, the University of California Hospitals in San Francisco among the best.
Any complete diagnostic evaluation should also investigate the reasons for your husband’s pneumonia, pleurisy and bronchitis. In this regard, it would be wise to repeat the alpha-1 level and your husband’s associated phenotype (you can ask the consultant about this). I would also mention that COPD occurs in clusters in some families and it would be of interest to look to other family members with the early onset (age 32) of serious respiratory disease.
Finally, your husband should be checked for Cystic Fibrosis as this is a chronic respiratory disease that need not occur in childhood, but may manifest in early adulthood and, for that reason remain undiagnosed.
Whatever you do, do not accept pat answers. You must seek answers whatever it takes.
Thank you for your answer!
We live in Canada (Halifax, Nova Scotia). Do you have any suggestions for Medical Centres or specialists in this area or in Canada? We would not receive coverage for seeing a specialist in the United the States.
As for his family members, the only known family member of his that has respiratory problems is his grandfather (mother's father). He has emphysema and is 82. It was probably about in his 60's that he began having respiratory problems. My husband is also the only one in his family that has asthma. Even our two year old son is perfectly healthy with no respiratory problems.
There was one other thing I forgot to mention (my mother-in-law reminded me). My husband did asbestos removal for about 3 months when he was about 21 years old or so. The problem is that it was a really shoddy company that didn't do proper training nor warning and education about asbestos. They didn't do proper decontamination and would sometimes take their masks off in the sealed off areas. I'm not sure if the asbestos would have something to do with this?
We are seeking answers, but unfortunately the waits to see some doctors can range from months to years (it took my husband over 2 years to see his sleep doctor... and he was on a cancellation list). In order to get things done quickly, it seems as though we have to do our own research, and tell our family doctor which tests to order. Unfortunately that is the nature of universal healthcare in Canada.
So my question was... what is this test called so we can tell my husband's doctor to order it and get this cleared up?
I also forgot to mention that his grandfather smoked like a chimney since he was 8 years old and didn't quit until his 60's.