Table of Contents
Include in assessment
- History: baseline and severity, exacerbation history, ICU admissions, normal PEFR (if asthmatic), infective symptoms, inhaler compliance, home oxygen/nebs
- PEFR regularly (in asthma)
- Investigations:
- ABG (should suggest hyperventilation asthma; if hypoxaemic/hypercapnic, patient is tiring)
- CXR (exclude pneumothorax)
- Bloods (including regular potassium monitoring)
Classifying asthma severity
- Life-threatening (PEFR <33%): 33, 92 CHASE
- 33: PEFR <33% predicted
- 92: Sats <92%
- Cyanosis
- Hypotension
- Arrhythmia
- Silent chest
- Exhaustion
- Severe (PEFR <50%): cannot complete sentences, respiratory rate > 25, heart rate >110
- Moderate (PEFR <75%)
- Mild (PEFR >75%)
Treating asthma exacerbation: O SHIT ME!

Reference: BTS/SIGN ‘Guideline for the management of asthma’ 2019
Treating COPD exacerbation
- O SHIT as in asthma but prednisolone dose is 30mg OD and give controlled oxygen, i.e. 24-28% (venturi mask), and do regular ABGs to determine further oxygen therapy (see prescribing notes on oxygen therapy)
- Antibiotics: prescribe if any signs of infection as per local guidelines, e.g. doxycycline
- Chest physiotherapy
- Consider BiPAP in hypercapnic respiratory acidosis not responding to medical management (or if you achieve oxygen sats of 88-92%/PaO2 ≥8 without a hypercapnic respiratory acidosis despite medical management)
If hypoxaemia/hypercapnia is worsening despite maximal therapy, involve senior/anaesthetist with a view to intubation and ventilation.
Intensive care indications
- Requiring ventilator support
- Worsening hypoxaemia / hypercapnia / acidosis
- Exhaustion
- Drowsiness / confusion
Try some questions
What is procalcitonin and how could this help in management?
Oops! This section is restricted to members.
How are nebulisers best administered?
Oops! This section is restricted to members.
What are the adverse effects of back-to-back salbutamol nebulisers?
Oops! This section is restricted to members.