Persistent airflow limitation due to airway/alveolar abnormalities from noxious exposures; post-BD FEV1/FVC <0.7.
History taking
- • Chronic cough, sputum, progressive dyspnoea (mMRC)
- • Smoking pack-years, biomass exposure, occupational dusts
- • Exacerbations in last year, hospitalisations, home O₂
- • Comorbidities: IHD, HF, depression, osteoporosis
Examination
- • Pursed-lip breathing, barrel chest, hyperinflation
- • Reduced air entry, prolonged expiration, wheeze
- • Signs of cor pulmonale: raised JVP, pedal oedema
Red flags
- • Acute exacerbation with hypercapnia, drowsiness, cyanosis
- • Severe dyspnoea, RR>30, SpO₂<88% on room air
- • Haemoptysis — exclude malignancy
Differential diagnosis
- • Asthma, bronchiectasis, heart failure
- • TB, lung cancer, pulmonary fibrosis
Recommended investigations
- • Post-bronchodilator spirometry (gold standard)
- • CBC, CXR, ABG if SpO₂ <92% or severe
- • Alpha-1 antitrypsin in young/non-smoker COPD
- • ECG, echo for cor pulmonale
Diagnosis
- • Spirometry FEV1/FVC <0.7 post-BD
- • GOLD stages by FEV1; ABCDE groups by symptoms + exacerbations
Initial treatment / management
- • Smoking cessation (most important), pulmonary rehabilitation
- • LABA + LAMA inhaler for most symptomatic patients
- • Add ICS if eosinophils ≥300 or frequent exacerbations
- • Vaccination: influenza, pneumococcal, COVID, pertussis
- • Long-term O₂ if PaO₂ ≤55 mmHg or SpO₂ ≤88%
Prescription examples
- • Tiotropium 18 µg inhaler — 1 puff OD
- • LABA-LAMA combo (e.g., Indacaterol-Glycopyrronium) — 1 puff OD
- • Salbutamol inhaler 100 µg — 2 puffs PRN
- • Exacerbation: Prednisolone 40 mg OD x 5 d ± Amoxicillin-Clavulanate 625 mg TDS x 5 d
Follow-up advice
- • Review 4–6 weeks after start; then 3–6 monthly
- • Annual spirometry, exacerbation review
Patient counselling
- • Smoking cessation is THE single most effective intervention
- • Pulmonary rehabilitation, exercise, nutrition
- • Recognise exacerbation early — change in sputum colour/volume, increased dyspnoea
Referral criteria
- • Severe disease (FEV1<30%), recurrent exacerbations
- • Suspected lung cancer, alpha-1 antitrypsin deficiency
- • Cor pulmonale, hypoxaemia for LTOT assessment
Clinical pearls
- • Reversibility on spirometry does NOT exclude COPD
- • ICS-only therapy is NOT recommended in COPD
- • Eosinophil count guides ICS use
References
- • GOLD Report 2024 (Global Strategy for COPD)
- • NICE NG115: COPD in over 16s
Educational outpatient guide — verify against local guidelines before clinical use.
