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Chronic Obstructive Pulmonary Disease (COPD)

Also known as: COPD · emphysema · chronic bronchitis

Chronic, progressive airflow limitation (not fully reversible) from noxious exposures — persistent cough, sputum and breathlessness. Smoking and biomass smoke are the key causes.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Older adults with a smoking history or biomass/occupational exposure (a major cause in Indian women). Often under-diagnosed.

Red flags — escalate / refer

Exacerbation with severe distress, confusion, cyanosis or drowsiness (CO₂ retention) → emergency; consider NIV/ICU.
Do NOT give uncontrolled high-flow oxygen — target SpO₂ 88–92% to avoid worsening hypercapnia.

Work-up / diagnosis

1Confirm with post-bronchodilator spirometry: FEV₁/FVC <0.70 = persistent airflow limitation.
2Assess symptoms (mMRC/CAT) and exacerbation history; screen comorbidities; pulse oximetry/ABG if severe.
3Chest X-ray to exclude alternatives/complications.

Management — overview

Stable disease: inhaled long-acting bronchodilators (LABA and/or LAMA) are the backbone; add inhaled corticosteroid for frequent exacerbations or high eosinophils.
Smoking cessation is the single most effective intervention; add vaccination (influenza, pneumococcal) and pulmonary rehabilitation.
Exacerbation: increase short-acting bronchodilators, a short course of systemic corticosteroids, and antibiotics if sputum is more purulent/increased; controlled oxygen to 88–92%.
Hypercapnic respiratory failure: non-invasive ventilation (NIV).

In-depthFull dosing & advanced protocol

Drug dosing

Long-acting bronchodilator (LAMA ± LABA)

Maintenance (stable COPD)

Adult dose: Inhaled maintenance (e.g. tiotropium); salbutamol PRN as reliever
Route: Inhaled

OtherGOLD — Global Initiative for Chronic Obstructive Lung Disease ↗

Prednisolone (systemic corticosteroid)

Acute exacerbation

Adult dose: 40 mg once daily for 5 days
Route: Oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Antibiotic (purulent exacerbation)

Increased sputum purulence/volume

Adult dose: e.g. amoxicillin or doxycycline per local guidance, ~5 days
Route: Oral

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

GOLD groups, ICS & oxygen

Use the GOLD ABE assessment to guide inhaler choice; reserve ICS for exacerbation-prone/eosinophilic patients (pneumonia risk).
Long-term oxygen therapy improves survival only in chronic severe hypoxaemia (meet the criteria on repeated testing).
Controlled oxygen (88–92%) prevents CO₂ narcosis; escalate to NIV for hypercapnic acidosis.

OtherGOLD — Global Initiative for Chronic Obstructive Lung Disease ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Tuberculosis (drug-sensitive) — NTEPInfection by Mycobacterium tuberculosis. India's National TB Elimination Programme (NTEP) provides free diagnosis and treatment; every case must be notified.Community-Acquired PneumoniaAcute lower-respiratory infection acquired outside hospital — fever, cough, sputum and breathlessness with a new infiltrate on chest X-ray. Streptococcus pneumoniae is the commonest cause.Bronchial AsthmaChronic airway inflammation with variable, reversible airflow obstruction — wheeze, cough, breathlessness and chest tightness. Inhaled corticosteroids are the cornerstone; never treat with a reliever alone.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Long-acting bronchodilator (LAMA ± LABA)

Prednisolone (systemic corticosteroid)

Antibiotic (purulent exacerbation)

📈 GOLD groups, ICS & oxygen

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Long-acting bronchodilator (LAMA ± LABA)

Prednisolone (systemic corticosteroid)

Antibiotic (purulent exacerbation)

📈 GOLD groups, ICS & oxygen

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

GOLD groups, ICS & oxygen

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

GOLD groups, ICS & oxygen

References