COPD: The Ultimate Lung Sabotage – Why It's a Nightmare in PHTLS

Feb 203 min read

Ah, Chronic Obstructive Pulmonary Disease (COPD) – the respiratory system’s equivalent of a slow-motion car crash. It’s as if your lungs have decided they’ve had enough, staged a protest, and left you gasping for air like a fish out of water.

But what exactly is COPD? Let’s break it down before things spiral into an oxygen crisis.

What Is COPD?

COPD is a progressive lung disease that makes breathing as difficult as trying to drink a thick milkshake through a straw. It’s an umbrella term covering chronic bronchitis (where mucus production goes into overdrive) and emphysema (where the alveoli collapse like a deflated balloon).

Rather than functioning like elastic, efficient lungs, COPD-affected lungs become inflamed, rigid, and inefficient, trapping air and making exhalation a real struggle.

What Causes COPD?

In short: a mixture of lifestyle choices and bad luck.

Smoking – The primary culprit. If lungs could file a legal complaint, smoking would be a serious offence.
Long-term exposure to airborne irritants – Dust, air pollution, chemical fumes—essentially anything other than fresh, clean air.
Genetic Factors (Alpha-1 Antitrypsin Deficiency) – A rare genetic condition where the lungs lack crucial protective enzymes, leading to early-onset emphysema.

What COPD Does to the Body

COPD turns the lungs into inefficient, mucus-clogged air sacs that hoard carbon dioxide (CO₂) instead of exhaling it properly. Here’s what happens:

Airway inflammation – The walls thicken, the passages swell, and goblet cells produce excessive mucus.
Alveolar destruction – The gas exchange structures in the lungs (alveoli) break down, reducing oxygen absorption.
Air trapping – The patient inhales but struggles to exhale, leading to hyperinflation of the lungs.
Chronic hypoxia & hypercapnia – Oxygen levels decrease (hypoxia), while CO₂ builds up (hypercapnia), causing confusion, fatigue, and respiratory distress.

Why Is COPD a Problem in PHTLS?

Now, let’s discuss why COPD patients present a significant challenge in Prehospital Trauma Life Support (PHTLS).

They Depend on Hypoxic Drive – Unlike most patients, COPD sufferers rely on low oxygen levels to stimulate breathing. Administering too much oxygen can suppress their respiratory drive, leading to CO₂ retention and respiratory failure.
Bag-Valve Mask (BVM) Ventilation Can Be Dangerous – If you ventilate too quickly, you risk air trapping, increasing intrathoracic pressure, and potentially causing cardiac arrest.
Increased Risk of Shock – COPD patients already have compromised oxygenation. Add trauma, bleeding, or hypotension, and they deteriorate alarmingly fast.

How to Manage COPD in PHTLS?

So, how do you keep your COPD patient from crashing before they reach the hospital? Follow these key steps:

Controlled Oxygen Delivery
- Aim for SpO₂ levels of 88-92% (not 100%—we’re avoiding CO₂ narcosis here).
- Use a Venturi mask or nasal cannula instead of cranking up a non-rebreather mask.
Slow and Gentle Ventilation
- If bagging is necessary, use a slow rate and low tidal volume (8-10 breaths per minute).
- Allow for full exhalation between breaths to prevent air trapping.
Consider CPAP/BiPAP
- If the patient is still breathing but struggling, non-invasive positive pressure ventilation (NIPPV) can help keep airways open and clear excess CO₂.
Monitor for Signs of Decompensation
- Altered mental state? CO₂ is accumulating.
- Respiratory fatigue? They may need advanced airway support soon.
- Silent chest? Immediate emergency – airflow has stopped, and they need urgent intervention.

Final Thoughts

COPD in PHTLS is like handling a house of cards made of mucus and failing alveoli.

Too much oxygen? They may stop breathing.
Too aggressive with ventilation? You risk hyperinflation and a cardiac event.
Not enough support? They will decompensate rapidly.

Your best approach? Slow, controlled oxygen delivery and mindful ventilation. Master these, and you’ll improve your patient’s chances of making it to hospital without a major respiratory catastrophe.

Stay safe, Kraken Medics – and keep breathing (unlike your COPD patients).