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 CHEST
  • 33: PEFR <33% predicted
  • 92: Sats <92%
  • Cyanosis
  • Hypotension
  • Exhaustion
  • Silent chest
  • Tachycardia
• Severe (PEFR <50%): cannot complete sentences, respiratory rate > 25, heart rate >110
• Moderate (PEFR <75%)
• Mild (PEFR >75%)

Treating asthma exacerbation: O SHIT ME!

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

Here’s some OSCE stations

1. Acute assessment – shortness of breath II
2. COPD data interpretation
3. Asthma exacerbation prescribing
4. COPD exacerbation prescribing
5. Infective Exacerbation of COPD history
6. Asthma exacerbation history
7. Find more here