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COPD Escalation — SCE Respiratory MCQ

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Hard"Respiratory Medicine"COPD EscalationSCE Respiratory

A patient with BMI 47 kg/m² has daytime PaCO₂ 7.1 kPa, serum bicarbonate 33 mmol/L and severe obstructive sleep apnoea. CPAP used reliably for eight weeks leaves persistent nocturnal hypoventilation and daytime hypercapnia. What is the next step?

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Correct answer: D — Switch to non-invasive ventilation

This is obesity hypoventilation syndrome with inadequate response to adherent CPAP. NICE recommends non-invasive ventilation when CPAP does not sufficiently improve hypercapnia or nocturnal hypoventilation. Oxygen alone can worsen carbon-dioxide retention and does not correct the underlying ventilatory failure.

Reference: https://www.nice.org.uk/guidance/ng202