Similar to Asthma, COPD can also cause difficulty breathing due to inflammation and mucus in the airways. Additionally, alveoli may become damaged and impact gas exchange. Unlike asthma, COPD is caused by long-term damage to the lungs (often cigarette smoking).

Why CPAP?

• CPAP helps to splint open the airways ​
• This is accomplished through continuous positive pressure being applied during the entire respiratory cycle​
• This splinting is useful to keep alveoli and inflamed airways open and reduce fluid accumulation in the alveoli​
• Overall:​
• This splinting may help reduce respiratory effort and workload, and increase pulmonary compliance

When to Consider CPAP

• For a patient experiencing a COPD exacerbation, CPAP may be the first intervention, before salbutamol, when there is SEVERE respiratory distress​
• As outlined in the Conditions, this patient will be tachypneic with use of accessory muscles and/or an SpO2 <90%​
  • This patient will be obviously working hard to breathe​
  • You may observe 1-2 word dyspnea ​
• Although there are no LOA parameters, your patient should not be in such respiratory compromise that they are unable to sit up, unable to follow directions, or are not protecting their airway​
  • As outlined in the Contraindications​
  • This state would necessitate moving to BVM ventilations

Other Considerations​

• Salbutamol can still be administered via the MDI adapter while CPAP is ongoing. ​
  • We know the benefits of Salbutamol for patients experiencing bronchoconstriction from our first Bronchoconstriction Tip! ​
• Continue to titrate FiO2 and cm H2O until the patient has an SpO2 ≥ 92% and decreased work of breathing. ​
• Do not remove CPAP upon patient improvement ​
  • The CPAP has begun working and removal may trigger a worsening of symptoms​
  • Remove only if contraindications develop (ex. hypotension)

Summary​

For patients experiencing a COPD exacerbation, CPAP may improve the patient's work of breathing by splinting open the airways. COPD can be a first intervention for patients in severe respiratory distress or applied later if initial treatment with Salbutamol is ineffective. It is not a treatment for asthma exacerbations. ​

N.B: CPAP is an Aerosol Generating Medical Procedure (AGMP), so consider wearing appropriate PPE when in use. 

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