Respiratory17 UKMLA questions
Chronic Obstructive Pulmonary Disease (COPD) — UKMLA Revision Notes
COPD is a common, preventable, and treatable disease characterised by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases — most commonly cigarette smoke.
Key Facts
- Diagnosis requires spirometry: FEV1/FVC <0.70 post-bronchodilator
- Severity classified by FEV1: GOLD 1 (≥80%), 2 (50–79%), 3 (30–49%), 4 (<30%)
- Smoking cessation is the single most effective intervention
- Inhaled bronchodilators (SABA, LAMA, LABA) are the mainstay of treatment
- Acute exacerbation: increased breathlessness, sputum, wheeze — treat with bronchodilators, steroids, antibiotics
Investigations
- Spirometry: post-bronchodilator FEV1/FVC <0.70 confirms obstruction
- CXR: hyperinflation, flattened diaphragm, bullae
- ABG: type 2 respiratory failure in severe disease
- FBC: secondary polycythaemia, anaemia
- CT chest: emphysema distribution, exclude malignancy
Management
- Smoking cessation: most important intervention at any stage
- SABA (salbutamol) PRN: all patients
- LAMA (tiotropium) or LABA: add for persistent breathlessness
- Triple therapy (LAMA + LABA + ICS): frequent exacerbations or eosinophils ≥300
- Pulmonary rehabilitation: improves exercise tolerance and quality of life
NICE Guideline: NICE NG115 — Chronic obstructive pulmonary disease in over 16s (2018, updated 2022)
Related UKMLA Conditions
AsthmaPneumoniaLung CancerPulmonary Hypertension