Progressive airflow limitation from chronic bronchitis and/or emphysema, mostly smoking-related.
Causes
- • Tobacco smoke
- • Biomass exposure
- • α1-antitrypsin deficiency
Clinical features
- • Chronic productive cough
- • Progressive exertional dyspnoea
- • Frequent chest infections
Examination
- • Barrel chest, accessory muscle use
- • Reduced breath sounds, wheeze
- • Cyanosis, cor pulmonale signs
Investigations
- • Post-BD spirometry FEV₁/FVC <0.7
- • CXR (hyperinflation, bullae)
- • ABG, FBC (polycythaemia)
- • α1-AT if <45 yr / non-smoker
Diagnosis
- • GOLD A–D by symptoms + exacerbations; severity by FEV₁ (GOLD 1–4)
Management
- • Smoking cessation (largest mortality benefit)
- • LAMA ± LABA; add ICS if eosinophils ≥300 or exacerbations
- • Pulmonary rehab
- • LTOT if PaO₂ ≤7.3 (or ≤8 with cor pulmonale)
- • Vaccination (influenza, pneumococcal, COVID)
Complications
- • Exacerbation
- • Cor pulmonale
- • Pneumothorax
- • Lung cancer
Clinical pearls
- • Target SpO₂ 88–92% in known CO₂ retainers
- • Roflumilast for severe chronic bronchitis with frequent exacerbations
References
- • GOLD 2024
Educational — verify locally.
