How Chest X-Rays Can Help Diagnose COPD

If your healthcare provider suspects you have chronic obstructive pulmonary disease (COPD), you will be likely be asked to have a chest X-ray. A chest X-ray is a simple, non-invasive imaging technique that uses electromagnetic waves to create a one-dimensional picture of your heart, lungs, and diaphragm.

Hispanic doctors examining x-ray of chest
REB Images / Getty Images

While a chest X-ray cannot make a diagnosis of COPD, especially in early-stage disease, it can help support it. By and large, an abnormal chest X-ray is generally only seen when the damage to the lungs is extensive.

What a Chest X-Ray Can Tell Us

In early-stage disease, a chest X-ray may, in fact, appear quite normal. This doesn't mean that there is no damage; it is simply that the test has limitations as to how much it can visually tell us. It can neither describe your individual lung capacity nor the force by which you can inhale or exhale air.

What it can do is give us a visual reference point by which to compare any changes that may develop over time. As such, healthcare providers will typically recommend a chest X-ray every one or two years depending on how far along your COPD is.

In later-stage disease, visual changes will become more apparent. One of the most obvious features will be the so-called hyperinflation of the lungs. When this happens, the healthcare provider will be able to see several things on the X-ray:

  • A flattening of the diaphragm as the lungs press down on the muscle
  • Increased chest size as measured from front to back
  • An elongated and narrow heart
  • Pockets of air called bullae around a half inch in size or larger

In the event your healthcare provider needs a more extensive view of the lung structure and damage, a computed tomography (CT) scan may be ordered. Where a chest X-ray will only deliver a one-dimensional image of the lungs, a CT scan will take a series of images to create a more three-dimensional representation. In doing so, the CT scan can pick up finer detail and provide healthcare providers a more complete portrait of the person's COPD.

How COPD Is Diagnosed

To make an accurate diagnosis of COPD, a comprehensive evaluation would be performed to provide a baseline assessment of your current health, your family history, your smoking status, and any environmental or occupational toxins you may have been exposed to.

In addition to a chest X-ray, you may be asked to undergo one or several of the following tests:

If a positive diagnosis is returned, your healthcare provider would next determine the stage of your disease and design a treatment plan to help slow the progression of COPD.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Washko GR. Diagnostic imaging in COPDSemin Respir Crit Care Med. 2010;31(3):276–285. doi:10.1055/s-0030-1254068

  2. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med. 2017;195(5):557-582. doi:10.1164/rccm.201701-0218PP

By Deborah Leader, RN
 Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD.