Progressive airflow limitation due to airway and/or alveolar abnormalities, not fully reversible.
Causes
- • Smoking (90%)
- • Biomass / occupational exposure
- • α₁-antitrypsin deficiency
Clinical features
- • Chronic productive cough
- • Progressive dyspnoea
- • Wheeze
- • Frequent winter exacerbations
Investigations
- • Spirometry post-bronchodilator FEV1/FVC <0.7 (GOLD)
- • CXR (hyperinflation, bullae)
- • α₁-antitrypsin if <45 y or non-smoker
Management
- • Smoking cessation (single most effective)
- • LAMA ± LABA ± ICS by GOLD A–E
- • Pulmonary rehab
- • LTOT if PaO₂ ≤7.3 kPa
- • Vaccines (flu, pneumococcal, COVID)
Drug therapy
- • Tiotropium 18 mcg OD
- • Salmeterol-fluticasone if frequent exacerbations / eosinophils >300
- • Azithromycin 250 mg 3×/wk if frequent exacerbator
Complications
- • Type 2 RF, cor pulmonale, pneumothorax, depression
Clinical pearls
- • ICS adds risk of pneumonia — reserve for eosinophilic / frequent exacerbator phenotype
References
- • GOLD 2024
Educational — verify locally.
