Recognise / red flags: Assess worsening dyspnoea, cough and sputum together with respiratory rate, work of breathing, hypoxaemia, drowsiness or haemodynamic compromise. Exclude pneumonia, PE, heart failure and pneumothorax.
Investigate / stratify: For patients admitted with exacerbation, measure blood gases with oxygen concentration recorded, CXR, ECG, blood counts and electrolytes; evaluate hypercapnic respiratory acidosis and the need for NIV.
Initial management: Use short-acting bronchodilators and controlled oxygen (usually target SpO₂ 88–92% in hypercapnia-risk patients pending blood gases). NICE recommends oral prednisolone 30 mg daily for 5 days when indicated; antibiotics depend on sputum changes, illness severity and resistance risk rather than every exacerbation.
Exam pitfall / safety: Antibiotic use is not automatic. Review potential CO₂ retention, inhaler technique, smoking cessation, vaccinations and pulmonary rehabilitation after the episode.

Source checked 2026-10-30: NICE NG115 and NG114. Focused teaching summary only; historical material below has not had a full dose-by-dose review. Use current BNF, local guidelines and specialist advice for individual patients.

Related Subjects: |Emphysema |Chronic Bronchitis |Chronic Obstructive Pulmonary Disease (COPD)

🌬️ COPD is largely preventable – 🚭 smoking cessation is the single most effective intervention. 🔑 Think COPD in people >35 with a smoking history and exertional breathlessness, chronic cough, sputum, wheeze, or recurrent “winter bronchitis”. 📉 Diagnosis is supported by post-bronchodilator spirometry: FEV1/FVC <0.7.

🚨 Acute Exacerbation (NICE-aligned)

ABC assessment 🩺 – check SpO₂, RR, BP, pulse, ECG, and mental state; watch for exhaustion or confusion.
Controlled oxygen 💨 – aim for the person’s target range; 88–92% if at risk of hypercapnic respiratory failure.
Bronchodilators 💊 – nebulised salbutamol + ipratropium; use air-driven nebuliser if hypercapnic.
Steroids 💉 – prednisolone 30 mg PO daily for 5 days; no taper for a short uncomplicated course.
Antibiotics 🦠 – only if features suggest bacterial infection, following NICE antimicrobial guidance/local policy.
ABG 🩸 – repeat if severe or deteriorating; rising PaCO₂ with acidosis = type 2 respiratory failure.
NIV 😷 – if persistent hypercapnic acidosis despite optimal medical therapy.
Supportive care – VTE prophylaxis, fluids/electrolytes, nutrition, and early senior/respiratory input.

💡 Exam tip: Confusion + rising PaCO₂ + acidosis = urgent NIV. 🎯 In COPD at risk of CO₂ retention, target sats are usually 88–92%, not 100%.

📖 Overview

Usually smoking-related; includes features of emphysema and/or chronic bronchitis.
Pathophysiology: chronic airway inflammation + mucus + small-airway narrowing + loss of elastic recoil → air trapping and hyperinflation.
Advanced disease may lead to hypoxia, hypercapnia, pulmonary hypertension, and cor pulmonale.

⚠️ Risk Factors

🚬 Smoking (main cause)
🧬 Alpha-1 antitrypsin deficiency
⛏️ Occupational dusts/fumes and indoor biomass exposure
📈 Increasing age

🧑‍⚕️ Clinical Features

Exertional dyspnoea, chronic cough, sputum, wheeze, fatigue.
Barrel chest, prolonged expiration, pursed-lip breathing, reduced breath sounds.
Late signs: cyanosis, oedema, raised JVP, cor pulmonale.

🫁 CAT Score in COPD

The COPD Assessment Test (CAT) is an 8-item patient questionnaire used to assess the symptom burden and impact of COPD on daily life. It does not diagnose COPD, but helps monitor severity, guide treatment review and assess response over time.

📋 CAT Score Domains

Question area	What it assesses
Cough	How much the patient coughs.
Phlegm	Amount of sputum/mucus production.
Chest tightness	Degree of chest tightness.
Breathlessness	Dyspnoea when walking uphill or climbing stairs.
Activity limitation	Restriction doing activities at home.
Confidence leaving home	How confident the patient feels going out.
Sleep	Whether COPD affects sleep quality.
Energy	Impact on tiredness and energy levels.

🔢 Scoring

There are 8 questions. Each is scored from 0 to 5.
Total score ranges from 0 to 40.
Higher score = greater COPD symptom burden and impact on quality of life.

📊 Interpreting the CAT Score

CAT score	Impact level
0–10	Low impact
11–20	Medium impact
21–30	High impact
31–40	Very high impact

🧠 Clinical Use

Used alongside symptoms, exacerbation history, spirometry and functional status.
Helpful at COPD review to track whether the patient is improving or deteriorating.
A score of 10 or more usually suggests significant symptoms.
Review
- Inhaler technique
- Adherence
- Smoking status
- Pulmonary rehabilitation
- Vaccinations
- Comorbidities if the score is high.

⚠️ Important Point

CAT score should not be used alone to make treatment decisions.
Always interpret it with exacerbation frequency, MRC dyspnoea score, oxygen saturations, spirometry and clinical assessment.

🔎 Investigations

Spirometry: post-bronchodilator FEV1/FVC <0.7.
CXR to look for hyperinflation and exclude other pathology.
FBC for polycythaemia/anaemia.
ABG if severe disease, low sats, or exacerbation.
Alpha-1 antitrypsin if young, minimal smoking history, or family history.

💊 Chronic Management

Smoking cessation, vaccinations, inhaler technique, and self-management advice.
Pulmonary rehabilitation if functionally limited by breathlessness.
SABA or SAMA for symptom relief.
LABA+LAMA or LABA+ICS depending on whether there are asthmatic features/steroid responsiveness; escalate to triple therapy if needed.
LTOT for selected stable patients with chronic severe hypoxaemia after formal assessment.

🧠 Exam Pearls

COPD = clinical diagnosis supported by spirometry, not just a CXR label.
Post-bronchodilator FEV1/FVC <0.7 is the key number.
Prednisolone 30 mg for 5 days is the classic NICE exacerbation prescription.
Most exacerbations are triggered by respiratory infection.
Always check comorbidities: CVD, osteoporosis, anxiety/depression, lung cancer.

📚 References

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Chronic Obstructive Pulmonary Disease (COPD) ✅

COPD exacerbation — controlled treatment