Summary

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease characterised by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. Smoking is the primary risk factor. COPD is the third leading cause of death worldwide. Management focuses on smoking cessation, inhaled bronchodilators, and pulmonary rehabilitation. The GOLD guidelines provide a framework for assessment and treatment escalation based on symptoms and exacerbation history.

Key Facts

• Definition: Post-bronchodilator FEV1/FVC ratio under 0.70
• Prevalence: 10-12% of adults over 40 years
• Primary Cause: Tobacco smoking (85-90%)
• Mortality: Third leading cause of death globally
• Key Treatment: Smoking cessation is the only intervention proven to slow FEV1 decline
• Pharmacotherapy: LABA, LAMA, ICS (based on phenotype)

Structured Approach

General Inspection:

• Respiratory distress at rest or with minimal exertion
• Body habitus: Cachectic (emphysema) or overweight (chronic bronchitis)
• Use of accessory muscles (sternocleidomastoid, scalenes)
• Pursed-lip breathing
• Cyanosis (central or peripheral)

Vital Signs:

• Tachypnoea (RR > 20)
• Tachycardia
• SpO2: Often reduced, especially on exertion
• Pulsus paradoxus in severe exacerbation

Chest Examination:

Cardiovascular:

• Elevated JVP (cor pulmonale)
• Parasternal heave (RV hypertrophy)
• Loud P2 (pulmonary hypertension)
• Peripheral oedema (right heart failure)

Special Tests

GOLD Spirometric Classification

GOLD ABE Assessment (2024 Update)

Combines symptoms (mMRC/CAT) with exacerbation history:

mMRC Dyspnoea Scale

Key Guidelines

Landmark Trials

TORCH (2007)

• Salmeterol/Fluticasone vs placebo
• 17% reduction in exacerbations
• Did not reach primary mortality endpoint but established combination therapy

UPLIFT (2008)

• Tiotropium vs placebo over 4 years
• Reduced exacerbations by 14%
• Established LAMA as cornerstone therapy

IMPACT (2018)

• Triple therapy (FF/UMEC/VI) vs dual therapy
• 15% reduction in moderate/severe exacerbations
• 25% reduction in mortality (exploratory)
• Established triple therapy for high-risk patients

ETHOS (2020)

• Budesonide/Glycopyrrolate/Formoterol triple therapy
• Confirmed mortality benefit with ICS in exacerbators
• Eosinophil count predicts ICS response

Evidence-Based Recommendations

What is COPD?

COPD is a lung condition that makes it hard to breathe. It includes emphysema (damaged air sacs) and chronic bronchitis (inflamed airways with excess mucus).

What causes it?

Smoking is the main cause (85-90%). Other causes include dust, fumes, and rarely genetic conditions.

How is it treated?

1. Stop smoking: The single most important thing you can do. It's the only way to slow down the damage to your lungs.

2. Inhalers: Different types help in different ways:

   • Blue "reliever" inhalers for quick relief
   • Long-acting inhalers to keep airways open all day
   • Steroid inhalers if you have frequent flare-ups

3. Pulmonary rehabilitation: A 6-8 week programme of exercises and education that helps you manage your condition and stay active.

4. Vaccinations: Annual flu jab and pneumonia vaccine to prevent chest infections.

5. Oxygen therapy: Some patients with very low oxygen levels may need oxygen at home.

What are flare-ups (exacerbations)?

A flare-up is when your symptoms get suddenly worse - more breathlessness, more cough, more phlegm. These are often caused by infections and need early treatment with steroids and sometimes antibiotics.

Warning signs to seek help

Go to A&E or call 999 if you experience:

• Severe breathlessness that doesn't improve
• Confusion or drowsiness
• Lips or fingers turning blue
• Chest pain
• Coughing up blood

Living with COPD

• Stay as active as possible - gentle exercise is good for you
• Eat a healthy balanced diet
• Drink plenty of fluids to keep phlegm loose
• Take your medications regularly as prescribed
• Know your action plan for flare-ups
• Join a support group to meet others with COPD