COPD - Emergency Medicine (ED‑focused)
A concise, clinically oriented summary of COPD for the emergency department: recognition, acute‑exacerbation management, escalation to ventilatory support, disposition and practical ED pitfalls. Recommendations follow NICE (NG115, NG114) and Resuscitation Council UK guidance.
Definition and scope
Chronic obstructive pulmonary disease (COPD) is a progressive condition of persistent airflow limitation that is not fully reversible. The term covers chronic bronchitis, emphysema and other causes of fixed airflow obstruction. Exacerbations - acute, sustained worsening of symptoms beyond normal day‑to‑day variation - commonly drive ED attendance and morbidity.
Who to suspect Consider COPD in adults ≥ 35 years with:
- Progressive exertional breathlessness, chronic productive cough or frequent “winter bronchitis”
- Wheeze or reduced exercise tolerance
- Relevant exposures (smoking, occupational dusts/fumes, indoor biomass)
- Family history or early onset suggesting alpha‑1 antitrypsin deficiency
Diagnosis (key points)
- Confirm persistent airflow obstruction with post‑bronchodilator spirometry: FEV1/FVC < 0.70 (NICE NG115). Perform spirometry when clinically stable (not during an acute exacerbation).
- Interpret spirometry together with symptoms and exacerbation history; be aware of age effects on the fixed ratio.
- Use spirometric stage alongside clinical features to guide chronic management.
Spirometric severity (post‑bronchodilator FEV1 % predicted - traditional NICE staging)