Chronic Obstructive Pulmonary Disease (COPD) ✅

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

🔢 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

🧠 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

• NICE NG115 – COPD in over 16s
• NICE CKS – COPD
• BNF – COPD treatment summary