# COPD Management Guide for MSRA & NICE NG115 Revision
> Essential COPD management revision for MSRA exam. Covers NICE NG115 guidelines, diagnostic staging, inhaler escalation, acute management, and LTOT criteria.

Tags: copd, msra-revision, nice-guidelines, medical-education, respiratory-medicine, gp-training, inhaler-therapy
## COPD Management: MSRA High Yield
* Key revision points for FY2/GPST based on NICE NG115.

## Diagnosis & Severity Staging
* Diagnosis confirmed by post-bronchodilator FEV1/FVC < 0.7.
* GOLD 1 (Mild): FEV1 ≥ 80%.
* GOLD 2 (Moderate): FEV1 50–79%.
* GOLD 3 (Severe): FEV1 30–49%.
* GOLD 4 (Very Severe): FEV1 < 30%.

## Non-Pharmacological Management
* **Smoking Cessation:** Most important intervention. Offer NRT, Varenicline, or Bupropion.
* **Vaccinations:** Annual Influenza, one-off Pneumococcal, and COVID-19 boosters.
* **Pulmonary Rehab (PR):** Indicated if MRC Grade 3+.

## Pharmacological Step 1: Asthmatic Features?
* Start with SABA or SAMA PRN.
* **No Asthmatic Features:** LABA + LAMA.
* **Asthmatic Features (Eosinophilia/Atopy):** LABA + ICS.

## Step 2: Escalation to Triple Therapy
* Escalation to LAMA + LABA + ICS for persistent symptoms or exacerbations.
* 3-month trial: Withdraw ICS if no benefit to reduce pneumonia risk.

## Acute Exacerbation: Community Management
* **Anthonisen Criteria (Antibiotics):** Increases in dyspnoea, sputum volume, or sputum purulence (need 2/3).
* **Steroids:** Prednisolone 30mg for 5 days.
* **Antibiotics:** Amoxicillin, Clarithromycin, or Doxycycline for 5 days.

## Acute Exacerbation: Hospital Management
* **Target Sats:** 88–92% via Venturi.
* **Meds:** Nebulised Salbutamol + Ipratropium, Hydrocortisone/Prednisolone.
* **Prognosis:** DECAF Score (Dyspnoea, Eosinopenia, Consolidation, Acidemia, Fibrillation).

## Non-Invasive Ventilation (NIV) Criteria
* Failed maximal medical therapy for 1 hour.
* **Criteria:** pH < 7.35 and pCO2 > 6.0 kPa.
* **Contraindications:** Facial trauma, vomiting, pneumothorax.

## Long-Term Oxygen Therapy (LTOT)
* Requires 2 ABGs 3 weeks apart in stable non-smokers.
* **Group 1:** pO2 < 7.3 kPa.
* **Group 2 (7.3 – 8.0 kPa):** Requires Polycythaemia, Oedema, or Pulmonary Hypertension.
* Benefit requires minimum 15 hours/day usage.

## High Yield Exam Pearls
* **Azithromycin:** Check CT thorax and ECG (QT interval) before prophylaxis.
* **Cor Pulmonale:** Right heart failure; treat with LTOT and diuretics.
* **Red Flags:** Haemoptysis/weight loss requires urgent 2WW referral.
* **Theophylline:** Toxicity risk with P450 inhibitors (Macrolides/Ciprofloxacin).
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