GIVE high concentration oxygen

GIVE salbutamol 5mg by nebuliser (oxygen driven) and repeat CONTINUOUSLY

GIVE hydrocortisone 200mg IV if not taking steroids

If slow to improve

ADD ipratropium 500mcg by nebuliser (oxygen driven)

START intravenous fluids with added potassium

CONSIDER slow IV bolus of salbutamol 250mcg followed by infusion at 5mcg/min adjusted according to heart rate and response (range 3-20mcg/min)

CONSIDER aminophylline 5mg/kg IV bolus over 20 min followed by infusion at 0.5mg/kg/hr (no bolus if taking oral theophylline)


SpO2 (but will not detect a rising PaCO2)

ECG (especially if giving aminophylline)

Blood gases

Temperature (?underlying infection as trigger to acute event)

Consider CXR if suspicion of pneumonathorax or pneumonia


If becomes clinically exhausted

If PaCO2 > 6kPa (and consider electively if rises into normal range while still in respiratory distress)

Reproduced from British Thoracic Society guidelines

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