Symptoms & Clinical Features

• Progressive dyspnea (initially exertional)
• Chronic productive cough (typically >3 months/year for 2 consecutive years)
• Recurrent lower respiratory infections
• African presentation: Often younger patients with predominant chronic bronchitis phenotype from biomass exposure (Fullerton et al., 2011; Thorax)

Differential Diagnosis

• Asthma
• Bronchiectasis
• Tuberculosis sequelae
• Congestive heart failure
• Obliterative bronchiolitis

Investigations

1. Spirometry: Post-bronchodilator FEV₁/FVC <0.70 confirms persistent obstruction
2. Chest X-ray: Hyperinflation, flattened diaphragms, bullae
3. Alpha-1 antitrypsin: Testing in young patients/family history
4. 6MWT: Assess functional capacity
   Resource-limited setting: Peak flow meters and clinical questionnaires (COPD-PS) as screening tools (Akanbi et al., 2019; BMC Pulmonary Medicine)

Treatment

• Bronchodilators: LAMA/LABA combinations first-line
• ICS: Added for frequent exacerbations (≥2/year) or at least 1 exacerbation requiring hospitalization and eosinophilic phenotype (>300cell/ml)
• Pulmonary rehabilitation: Significant benefits shown in Nigerian programs
• Oxygen: Long-term for chronic hypoxemia (SpO₂ ≤88%) or presence of corpulmonale, polycythaemia. Long term oxygen therapy (LTOT) is low dose oxygen for at least 15 hours per day
• Biologics and other newer agents: Used particularly in eosinophilic phenotypes, persistent bronchitis, previous smokers among others. Dupilumab, Ensifentrine are some examples
• Non-pharmacologic: Smoking cessation, biomass smoke reduction interventions, non-invasive therapy, lung volume reduction therapy, vaccination.

Follow-up

• Quarterly for advanced disease
• Monitor exacerbation frequency, FEV₁ decline (≥40mL/year significant)
• Assess for complications (pulmonary hypertension, cachexia, etc)

Prevention & Control

• Primary: Tobacco control and smoking cessation, clean fuel initiatives (improved cookstoves)
• Secondary: Early detection through spirometry in high-risk groups
• Tertiary: Pulmonary rehabilitation, vaccination, exacerbation prevention
• Nigerian initiative: "Clean Air Nigeria" promoting liquefied petroleum gas adoption (Oluwole et al., 2017)

Conclusion and Experience from the clinic

COPD in Nigeria represents a dual burden of tobacco and biomass exposure. Public health interventions must address household air pollution while strengthening capacity for spirometry and rehabilitation services.

While most patients with COPD present late, some are already in respiratory failure in need of LTOT and others having recurrent exacerbation requiring hospital admission. Majority of those that are chronic smokers are still current smoker. This worsens lung function exponentially, expose them to the vicious cycle of infective exacerbation and bronchiectasis, and increase risk of lung malignancy. Smoking cessation is a very important aspect of COPD management, though difficult to achieve but rewarding. This should be reiterated to the patient at every clinic visit and supported with Nicotine replacement therapy.