Chronic Obstructive Pulmonary Disease

Abstract Summary Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide representing the fourth leading cause of death in the world. Chronic inflammation is responsible for repeated injury and repair and causes pathological changes in the airways, lung parenchyma, and pulmonary vasculature. These changes are responsible for airflow limitation and gas trapping, gas exchange abnormality, mucus hypersecretion, and pulmonary hypertension. Severe acute exacerbations of COPD (AECOPD) may be associated with acute hypercapnic respiratory failure. Management strategies include oxygen titration to achieve a saturation of 88%–92%, short-acting inhaled beta2-agonists with short-acting anticholinergics, systemic corticosteroids, and antibiotics in selected cases. Non-invasive ventilation (NIV) should be started when pH <7.35 and PaCO2 >45 mmHg persist despite initial medical management. Invasive mechanical ventilation should be considered if acidosis persists or worsens after NIV trial. The role of ECCO2R in preventing intubation during AECOPD and liberating from mechanical ventilation is promising and awaits definitive studies.