🌬️ 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.

🔎 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) ✅