COPD is the third leading cause of death in the US and is profoundly under-treated in primary care. NPs frequently manage COPD longitudinally, including initial spirometric diagnosis, GOLD-based inhaler escalation, exacerbation management, and admission triage. The most common errors are: under-diagnosing COPD, under-treating with only PRN SABA, over-relying on ICS without clear indication, and delaying pulmonary rehabilitation referral.