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COPD exacerbation with hypercapnic respiratory failure — MCCQE Part 1 MCQ

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HardDyspneaCOPD exacerbation with hypercapnic respiratory failureMCCQE Part 1

A 69-year-old woman with severe COPD presents with increasing dyspnea and purulent sputum. She is drowsy, using accessory muscles, and has a respiratory rate of 30/min. ABG on 28% oxygen shows pH 7.28, PaCO2 68 mmHg, PaO2 62 mmHg, and bicarbonate 30 mmol/L. What is the most appropriate next step in management?

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Correct answer: D — Start non-invasive positive-pressure ventilation

Acidotic hypercapnic respiratory failure in a COPD exacerbation is an indication for non-invasive ventilation in addition to bronchodilators, corticosteroids, and antibiotics when indicated. Increasing oxygen without ventilation may worsen CO2 retention and does not correct ventilatory failure. Spirometry is inappropriate during an acute exacerbation. Furosemide is not the primary treatment unless there is separate evidence of fluid overload.

Reference: Canadian Thoracic Society COPD guidance