Table of Contents Clinical featuresInvestigations Severity grading Management Inhaled therapyTabletsNon-pharmacologicalOxygen therapyHere are some questionsTry some stations Clinical features SymptomsExertional dyspnoeaChronic productive coughWheezeSignsAccessory muscle use Tar-stained fingersBounding pulseCO2 retention asterixisLip pursingCentral cyanosisTracheal tugHyperexpanded chestQuiet breath sounds/wheeze/prolonged expiratory phase Expiratory wheeze Investigations Spirometry Obstructive pattern: ↓FEV1 (<80%), normal FVC (>80%), ↓FEV1/FVC ratio (<0.7)FEV1 grades severityChest X-rayHyperinflation (>8 anterior ribs visible)Flat hemi-diaphragmsDecreased lung markingsBlack lesions (bullae)Prominent hila Severity grading MildFEV1 >80%ModerateFEV1 50-80%SevereFEV1 30-50%Very severeFEV1 <30% Management Inhaled therapy Abbreviations: SABA = short-acting β2 agonist; SAMA = short-acting muscarinic antagonist; LABA = long-acting β2 agonist; LAMA = long-acting muscarinic antagonist; ICS = inhaled corticosteroid SABA/SAMA nebulisers – may also be considered in severe disease Common inhalers SABA Ventolin (salbutamol) SAMA Atrovent (ipratropium) LABA + LAMA Anoro = Vilanterol + UmeclidiniumUltibro = Indacaterol + GlycopyrroniumDuaklir = Formoterol + AclidiniumSpiolto = Olodaterol + Tiotropium LABA + ICS Fostair = formoterol + beclomethasoneSeretide = salmeterol + fluticasoneSymbicort = formoterol + budesonide LABA + LAMA + ICS Trimbow = formoterol + glycopyrronium + beclomethasone Trelegy Ellipta = vilanterol + umeclidinium + Fluticasone Tablets Mucolytics, e.g. carbocisteineTheophylline Non-pharmacological Smoking cessationPulmonary rehabilitation Pneumococcal/influenza vaccinesLung transplant Oxygen therapy Long-term oxygen therapy: considered in chronic hypoxaemia if PaO2<7.3kPa (or <8kPa in presence of pulmonary hypertension or secondary polycythaemia)Ambulatory home oxygen therapy: considered if hypoxaemic on exertion/activity Learn more here…Learn how to manage an acute exacerbation of COPD here! Here are some questions What are the different inhaler devices available? Oops! This section is restricted to members. Create an account or log in to continue reading. Subscribe Log In How would you instruct a patient on how to use a metered dose inhaler? Oops! This section is restricted to members. Create an account or log in to continue reading. Subscribe Log In What is type 1 and type 2 respiratory failure? Oops! This section is restricted to members. Create an account or log in to continue reading. Subscribe Log In Try some stations COPD exacerbation prescribingCOPD data interpretationAcute management – COPDCOPD historyMore here!