Screenings if you have COPD
The NHS says chronic obstructive pulmonary disease (COPD) is a common condition that mainly affects middle-aged or older adults who smoke, and that many people do not realise they have it. (NHS) MedlinePlus says smoking is the main cause of COPD. (MedlinePlus) Testing for COPD is on spirometry and COPD screening. This page covers the checks for people who already have COPD, not inhalers, oxygen use, medicines or treatment.
A review at least once a year
NICE says to review people with COPD at least once per year and more frequently if indicated, and that people with very severe COPD reviewed in primary care should be seen at least twice per year. (NICE NG115) Its follow-up table lists these measurements at each review:
- mild, moderate or severe COPD (at least once a year): FEV1 and FVC, BMI and the MRC dyspnoea (breathlessness) score
- very severe COPD (at least twice a year): the same measurements plus SaO2 (oxygen saturation)
For very severe COPD, the same table also lists checks for the presence of cor pulmonale, the need for long-term oxygen therapy, the person's nutritional state and the presence of depression. (NICE NG115) See questions to ask your doctor.
Lung function over time
NICE says follow-up of all people with COPD should include recording the spirometry values from diagnosis and recording opportunistic spirometry measurements, because a loss of 500 ml or more over 5 years will show which people have rapidly progressing disease and may need specialist referral and investigation. (NICE NG115) How the test works and what FEV1 and FVC mean are on spirometry and COPD screening.
Oxygen level checks
NICE says to assess the need for oxygen therapy in people with: (NICE NG115)
- very severe airflow obstruction (FEV1 below 30% predicted)
- cyanosis (blue tint to skin)
- polycythaemia
- peripheral oedema (swelling)
- a raised jugular venous pressure
- oxygen saturations of 92% or less breathing air
NICE also says pulse oximetry should be available in all healthcare settings, that some pulse oximeters can underestimate or overestimate oxygen saturation levels, with overestimation reported in people with dark skin, and that people having long-term oxygen therapy should be reviewed at least once per year, including pulse oximetry. (NICE NG115) The NHS lists a blood oxygen test, a peg-like device attached to your finger, among the further tests that may be needed, (NHS diagnosis) and MedlinePlus says an arterial blood gas test may sometimes be done to measure the amounts of oxygen and carbon dioxide in the blood. (MedlinePlus)
Heart checks
GOLD says cardiovascular diseases, particularly hypertension, ischemic heart disease, heart failure and atrial fibrillation, are common in COPD, and that the risk of a major cardiovascular event is significantly increased during and up to one year after a moderate or severe exacerbation. (GOLD 2026) NICE uses an ECG and serum natriuretic peptides, and an echocardiogram, to assess cardiac status if cardiac disease or pulmonary hypertension are suspected, for example because of a history of cardiovascular disease, hypertension or hypoxia. (NICE NG115) MedlinePlus lists irregular heartbeat (arrhythmia) and right-sided heart failure or cor pulmonale among the possible complications of COPD. (MedlinePlus) See heart screenings by age, blood pressure screening and screenings if you have heart failure.
Anxiety and depression
NICE says to be alert for anxiety and depression in people with COPD, and to consider whether people have anxiety or depression, particularly if they have severe breathlessness, are hypoxic, or have been seen at or admitted to a hospital with an exacerbation of COPD. (NICE NG115) GOLD says depression and anxiety are frequent and important morbidities in COPD that are often under-diagnosed. (GOLD 2026) See depression screening: what to expect and anxiety screening (GAD-7).
Bone health
GOLD lists osteoporosis among the conditions that occur frequently with COPD and should be actively sought. (GOLD 2026) NICE says to monitor people having long-term oral corticosteroid therapy for osteoporosis. (NICE NG115) MedlinePlus lists thinning of the bones (osteoporosis) and severe weight loss among the possible complications of COPD. (MedlinePlus) See how often to have a bone density test.
Lung cancer screening
GOLD says lung cancer is a major cause of death in patients with COPD, that an annual low-dose CT (LDCT) scan is recommended for lung cancer screening in patients with a smoking history, similar to recommendations for the general population, and that screening for lung cancer in patients with COPD not associated with tobacco smoking is not recommended due to lack of evidence. (GOLD 2026) The USPSTF recommends annual screening with low-dose CT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years, and says to stop once a person has not smoked for 15 years. (USPSTF) NICE notes that emphysema on a CT scan is an independent risk factor for lung cancer. (NICE NG115) See lung cancer screening, low-dose CT lung scan: what to expect and screenings if you smoke.
Alpha-1 antitrypsin testing
NICE uses a serum alpha-1 antitrypsin test to assess for alpha-1 antitrypsin deficiency if COPD has an early onset, there is a minimal smoking history or there is a family history. (NICE NG115) The NHS says this is a rare genetic problem that increases your risk of COPD, (NHS diagnosis) and MedlinePlus says people who lack this protein can develop emphysema even without smoking. (MedlinePlus)
Usual screening on schedule
Apart from lung cancer screening, COPD does not change the general schedules for cancer and other screening in the sources on this page. (GOLD 2026)(NICE NG115) See preventive screenings for older adults, cancer screenings by age and screenings by age and gender.
When to contact a provider
MedlinePlus, COPD, when to contact a medical professional: (MedlinePlus)
Go to the emergency room or call 911 or the local emergency number if you have a rapid increase in shortness of breath.
Where they differ:
- Who gets lung cancer screening. GOLD recommends a yearly low-dose CT for people with COPD who have a smoking history and not for COPD unrelated to smoking; (GOLD 2026) the USPSTF sets the criteria by age (50 to 80), a 20 pack-year history and quitting within the past 15 years. (USPSTF)
- How often the oxygen level is part of the review. NICE lists SaO2 in the at least twice-yearly review for very severe COPD and pulse oximetry in the yearly review for people on long-term oxygen; (NICE NG115) the NHS describes a blood oxygen test as one of the further tests that may be needed. (NHS diagnosis)
- Depression checks. NICE names the presence of depression in its twice-yearly review for very severe COPD and asks clinicians to be alert for anxiety and depression in everyone with COPD; (NICE NG115) GOLD says multimorbidity, including depression and anxiety, should be actively searched for in each patient with COPD. (GOLD 2026)
Your doctor decides what your result means for you.
Questions people ask
How often should someone with COPD be reviewed?
NICE says to review people with COPD at least once per year and more frequently if indicated. When people with very severe COPD are reviewed in primary care, NICE says they should be seen at least twice per year. (NICE NG115)
Is lung cancer screening offered to people with COPD?
GOLD says an annual low-dose CT scan is recommended for lung cancer screening in patients with COPD who have a smoking history, similar to recommendations for the general population, and that screening for lung cancer in COPD not associated with tobacco smoking is not recommended due to lack of evidence. The USPSTF recommends annual low-dose CT screening for adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. (GOLD 2026) (USPSTF)
Is my oxygen level checked if I have COPD?
NICE says to assess the need for oxygen therapy in people with COPD who have, among other signs, oxygen saturations of 92% or less breathing air, and that pulse oximetry should be available in all healthcare settings. The NHS lists a blood oxygen test, a peg-like device attached to your finger, among the further tests that may be needed. (NICE NG115) (NHS diagnosis)
Does COPD change the usual cancer screening schedule?
Apart from lung cancer screening, the sources on this page do not set a different schedule for cancer or other routine screening in people with COPD. (GOLD 2026) (NICE NG115)