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Chronic obstructive pulmonary disease (COPD)
The diagnosis is made by spirometry (post-bronchodilator FEV1/FVC below 0.70), treatment is chosen by symptoms and exacerbations rather than FEV1, and only smoking cessation, long-term oxygen and NIV in defined settings clearly prolong life.
Why it matters in the exam
Exam stems describe a current or former smoker with exertional breathlessness and a chronic cough, and the candidate must recognise airflow obstruction that does not reverse on spirometry, place the patient in a GOLD group and choose the first inhaler. Another standard question is who qualifies for long-term home oxygen: the threshold is set by resting PaO2 or saturation, not by how breathless the patient feels. Candidates are also asked what lowers mortality (smoking cessation, oxygen, NIV for chronic hypercapnia after an admission) and what only improves symptoms (bronchodilators).
In an acute exacerbation, questions turn on the saturation target (88%–92%, so as not to worsen CO2 retention), when to add an antibiotic, how long to give steroids and when blood gases call for NIV. Exams also like alpha-1 antitrypsin deficiency: emphysema at a young age, mainly in the lung bases, sometimes with liver disease — which is why a single test is recommended for every COPD patient. The blood eosinophil count decides whether to add an ICS: at 300 cells per microlitre or more the benefit is clear, while below 100 there is little benefit and the risk of pneumonia rises.
Key points
- Diagnosis: post-bronchodilator FEV1/FVC below 0.70.
- First treatment follows the group: A one bronchodilator, B and E a LABA + LAMA combination.
- An ICS is added when eosinophils are 300 or more and there are exacerbations.
- Long-term oxygen when PaO2 is 55 mmHg or less or SaO2 88% or less, for at least 15 hours a day.
- In an exacerbation: saturation target 88%–92%, prednisone 40 mg for 5 days, and NIV when pH is 7.35 or less with hypercapnia.
Summary table
| Situation | Definition | First treatment | Exam note |
|---|---|---|---|
| Group A | 0–1 moderate exacerbations a year without admission, mMRC 0–1 and CAT below 10 | One bronchodilator (short- or long-acting) | Continue if symptoms improve |
| Group B | 0–1 moderate exacerbations without admission, mMRC 2 or more or CAT 10 or more | LABA + LAMA in a single inhaler | An ICS is not part of initial treatment |
| Group E | 2 or more moderate exacerbations, or one leading to admission | LABA + LAMA; add an ICS if eosinophils 300 or more | Do not give LABA + ICS without a LAMA |
| Long-term oxygen | Resting PaO2 55 mmHg or less or SaO2 88% or less; or PaO2 55–60 with cor pulmonale or haematocrit above 55% | Oxygen for at least 15 hours a day | Prolongs life |
| Acute exacerbation | Worse breathlessness, sputum volume and purulence | SABA ± SAMA, prednisone 40 mg for 5 days, saturation target 88%–92% | Antibiotic when the sputum is purulent |
Free exam questions
מטופל בן 59 , עם COPD קשה ברקע, מגיע בשל פריקת ירך. במהלך ההמתנה להחזרת הפריקה, סביב כאב ואגיטציה מתחיל לפתח קוצר נשימה. מהי תרופת הסדציה המועדפת במטופל זה לצורך החזרת הפריקה? (the question as examined, in Hebrew)
- א. קטמין
- ב. פרופופול
- ג. אטומידאט
- ד. מידזולם
בת 50 . ברקע : COPD . מתלוננת על כאבים בגרון וצרידות חדשה. בבדיקה אנדוסקופית נצפים הממצא ים שבסרטון :הבא 1.webm - https://media.examapp.co.il/300847/kwkwxcuh על מה מהבאים יש להמליץ במקרה זה ? (the question as examined, in Hebrew)
- א. CT צוואר עם חומר ניגוד והפניה לביופסיה
- ב. טיפול ב- Fluconazole
- ג. תרבית כיח וצילום חזה
- ד. טיפול קול ושינויים התנהגותיים להפחתת Reflux
כל התופעות הבאות הן תופעת לוואי של Proton Pump Inhibitor – PPI פרט ל - (the question as examined, in Hebrew)
- א. החמרת COPD
- ב. אי ספיקה כלייתית
- ג. זיהום ב- Clostridium difficile
- ד. שברים בעצמות
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Sources
- Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report, 2025 — Diagnosis, initial assessment and management of COPD and of exacerbations
- Harrison's Principles of Internal Medicine, 21st edition (2022) — Chronic Obstructive Pulmonary Disease
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.