COPD Defined
COPD = preventable, treatable lung disease characterized by persistent airflow limitation (FEV1/FVC <0.70). Progressive, not fully reversible (unlike asthma). Primary cause: cigarette smoking (85–90% of cases). Other: occupational exposures, biomass fuel, alpha-1 antitrypsin deficiency (genetic). Diagnosis: spirometry (post-bronchodilator FEV1/FVC <0.70).
Emphysema vs Chronic Bronchitis
Emphysema: alveolar wall destruction → air trapping → barrel chest, pursed-lip breathing, hyperresonance, decreased breath sounds. "Pink Puffer" — breathes hard to maintain O2. Chronic Bronchitis: excessive mucus production with productive cough ≥3 months/year for ≥2 consecutive years. "Blue Bloater" — hypoxic, hypercapnic, edematous. Most COPD patients have elements of both.
GOLD Staging
Based on FEV1 (% predicted, post-bronchodilator): GOLD 1 (Mild): FEV1 ≥80%. GOLD 2 (Moderate): 50–79%. GOLD 3 (Severe): 30–49%. GOLD 4 (Very Severe): <30%. GOLD also incorporates symptoms (mMRC dyspnea scale, CAT score) and exacerbation history to guide treatment. Higher GOLD = more aggressive pharmacotherapy.
Pharmacological Management
SABAs (albuterol): rescue — bronchodilation for acute dyspnea. LABAs (salmeterol, formoterol): long-term bronchodilation. LAMAs (tiotropium, umeclidinium): most effective long-acting bronchodilators for COPD. ICS (fluticasone): for frequent exacerbators with high eosinophils; risk of pneumonia. Combo inhalers (ICS/LABA, LABA/LAMA) improve adherence. Roflumilast: PDE4 inhibitor for severe COPD with frequent exacerbations.
Nursing Care & Exacerbation
Pursed-lip breathing: prolong expiration, prevent air trapping. Positions: high-Fowler's, tripod (lean forward on arms) — ease of breathing. Nutrition: small, frequent meals (large meals elevate diaphragm). O2 therapy: target SpO2 88–92% (hypoxic drive) — NOT 100%. COPD exacerbation: increased dyspnea, purulent sputum, increased cough. Tx: SABAs, systemic steroids, antibiotics (if bacterial infection), O2, possibly NIV (BiPAP).
Important Notes
- High-flow O2 in COPD patients can suppress hypoxic drive and cause CO2 retention and respiratory failure — target SpO2 88–92%.
- Smoking cessation is the ONLY intervention proven to slow COPD progression — always address.
Clinical Tips
- Barrel chest = AP diameter equal to lateral diameter — classic emphysema finding on inspection.
- Teach inhaler technique at every visit — most patients have poor technique; poor technique = poor drug delivery.
Summary
COPD is a progressive, largely preventable disease. Understanding the pathophysiology enables nurses to implement evidence-based interventions, prevent exacerbations, and support patients in maximizing quality of life.
