Asthma & COPD Exacerbations
Distinguish obstructive airway patterns and recognise respiratory failure without relying on wheeze alone.
Quick revision ↓ Medical Dictionary
01Confirm the underlying pattern
Asthma typically involves variable respiratory symptoms and variable expiratory airflow limitation. COPD is associated with persistent obstruction in an appropriate exposure and clinical context, confirmed with post-bronchodilator spirometry when stable. Smoking is important but not the only exposure. Consider bronchiectasis, cardiac disease and other mimics. A symptom label without objective review can lead to years of inappropriate treatment and missed alternatives.
02Recognise a severe attack
Assess ability to speak, respiratory effort, rate, oxygenation, pulse and consciousness. In acute asthma, exhaustion, altered consciousness or a quiet chest can indicate dangerously limited airflow rather than improvement. Peak flow can support assessment if feasible without delaying treatment. Rising or unexpectedly normal carbon dioxide in a struggling asthmatic patient is concerning and should prompt urgent senior or critical-care evaluation.
03Treat with monitored support
Acute bronchodilator therapy, anti-inflammatory treatment and oxygen are guided by severity and the relevant protocol. In patients at risk of hypercapnic respiratory failure, controlled oxygen and blood-gas assessment are important; excessive oxygen can worsen carbon-dioxide retention. Non-invasive ventilation may be indicated for selected COPD patients with persistent hypercapnic acidosis despite initial therapy, requiring appropriate monitoring and an escalation plan.
04Prevent the next exacerbation
Asthma management includes inhaled corticosteroid-containing treatment rather than relying on a short-acting reliever alone. Check the device, technique, adherence, triggers and access before escalating therapy. COPD care includes smoking cessation, appropriate inhaled treatment, vaccination and pulmonary rehabilitation. Individualise treatment to symptoms and exacerbation history, and review adverse effects. A prescription is ineffective if the patient cannot operate or obtain the inhaler.
05Discharge and review
Before discharge, confirm sustained improvement, appropriate oxygenation, an understandable treatment plan and safe support. Provide an action plan with warning symptoms and follow-up. Review the exacerbation trigger and whether maintenance care needs adjustment. Explain when increasing reliever use or falling function should prompt review rather than repeated self-management. Recurrent admissions suggest a need to revisit diagnosis, technique, comorbidities and practical barriers.
High-Yield Revision
- A silent chest in severe asthma can be life-threatening.
- Check inhaler technique before assuming treatment failure.
- Oxygen targets depend on hypercapnia risk and blood-gas findings.
Common Pitfalls
- Do not use reliever-only therapy as the routine long-term asthma strategy.
- Do not interpret less wheeze with exhaustion as recovery.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.