How can I effectively manage a patient with chronic respiratory acidosis due to COPD exacerbation in a primary care setting?

In primary care, effective management of a patient with chronic respiratory acidosis due to a COPD exacerbation involves careful clinical assessment and monitoring, with consideration for hospital referral if severity criteria are met. Initial assessment should include evaluation of symptoms such as worsening breathlessness, sputum changes, and oxygen saturation using pulse oximetry, being mindful of its limitations especially in borderline saturations or patients with dark skin. Arterial blood gas measurement is important if respiratory failure with hypercapnia or acidosis is suspected, but this is typically done in hospital settings. Management in primary care includes optimizing bronchodilator therapy, considering systemic corticosteroids and antibiotics if indicated, and providing respiratory physiotherapy with positive expiratory pressure devices to aid sputum clearance in selected patients. Monitoring recovery involves regular clinical assessment and pulse oximetry for non-acidotic patients; arterial blood gases should be monitored intermittently if hypercapnia or acidosis is present until stability is achieved. Referral to hospital is warranted if the patient has severe symptoms, impaired consciousness, cyanosis, worsening peripheral oedema, significant comorbidities, or arterial pH <7.35. Discharge planning after hospital treatment includes spirometry, re-establishing maintenance therapy, ensuring stable oxygenation or blood gases, and arranging follow-up and support. In primary care, ensuring the patient can cope at home and has adequate social support is essential. Overall, management in primary care focuses on early recognition, appropriate escalation, and supporting recovery while avoiding unnecessary hospital admission. ¹