COPD

Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent, non-reversible airflow limitation due to chronic bronchitis and emphysema. It is primarily caused by smoking and is associated with frequent infective exacerbations.

🎯 Key Learning Objectives

1. Diagnose COPD using post-bronchodilator spirometry (FEV1/FVC < 0.7).
2. Assess severity using GOLD criteria and mMRC dyspnoea scale.
3. Prescribe appropriate inhaler therapy based on eosinophil count and exacerbation history.
4. Manage acute exacerbations with bronchodilators, steroids, and antibiotics.
5. Identify indications for Long-Term Oxygen Therapy (LTOT).
6. Set appropriate oxygen targets (88-92%) for CO2 retainers.

🔬 Pathophysiology

Chronic inhalation of irritants leads to inflammatory cell infiltration, parenchymal destruction (emphysema), and small airway fibrosis. This causes air trapping and loss of elastic recoil.

🩺 Clinical Features

🔬 Investigations

💊 Management

⚠️ Complications

⭐ High-Yield Pearls

• Smoking cessation and LTOT are the only interventions that improve survival in COPD.
• LTOT criteria: PaO2 < 7.3 kPa when stable or < 8.0 kPa with polycythaemia/oedema.
• BiPAP (NIV) is indicated in acute exacerbations with respiratory acidosis (pH 7.25-7.35).
• Inhaled corticosteroids increase the risk of pneumonia in COPD patients.
• Alpha-1 antitrypsin deficiency should be screened for in young patients with COPD.

❓ Practice Questions