• Chronic cough, exertional SOB, frequent winter 'bronchitis' and wheeze together with regular sputum production are all characteristic presenting symptoms of COPD. Swollen ankles may point to an alternative diagnosis or to cor pulmonale, a late complication 

• Exacerbations: Prednisolone 30 mg PO 5/7 (patients with COPD exacerbations without more purulent sputum do not need antibiotic therapy unless there is consolidation on CXR or clinical signs of pneumonia.)

• Stable COPD who remain breathless or have exacerbations despite use of PRN SA bronchodilators, a combination of LAMA) and LABA if the patient has no asthmatic features or features suggesting steroid responsiveness. If asthmatic features or features suggesting steroid responsiveness then a LABA and inhaled corticosteroid (ICS)

LTOT

• Target oxygen saturation range for those at risk of hypercapnoeic respiratory failure (history of COPD): 88–92% 

• Oxygen is usually prescribed at a flow rate to maintain PaO2 of greater than 8 kPa. A flow rate of 1 litre per minute is usually initiated and then titrated up to as high as 4 litres per minute. Long term oxygen therapy (LTOT) should be prescribed for at least 15 hours a day up to 24 hours a day to gain optimum therapeutic benefit. Patients started on LTOT should be reviewed regularly. 

• LTOT patients should receive follow-up at three months after LTOT has been ordered, which should include assessment of blood gases and flow rate to ensure LTOT is still indicated and therapeutic. LTOT patients should receive follow-up visits at 6–12 months after their initial three-month follow-up, which can be either home based or in combination with hospital visits

• COPD (NICE) 

• Chronic Obstructive Pulmonary Disease (COPD) (CKS)

• COPD (NHS Choices)​

• South East London Integrated Guideline for the Management of COPD (SEL Responsible Prescribing Group, May 2016)

• COPD guidelines (British Thoracic Society)

• Guideline for Oxygen use in Healthcare and Emergency Settings (BTS)