Give oxygen

If pink puffer (thin, not cyanosed, pursed-lip breathing, no signs CO2 retention GIVE 35-40% by Ventimask

If blue bloater (signs CO2 retention, obese, cyanosed) GIVE 28% by Ventimask until blood gases known

If ABGs show PaCO2 < 6kPa and PaO2 < 10kPa continue oxygen at 28-40% and repeat ABGs at 30 mins to ensure CO2 not rising

If ABGs show CO2 retention use 24-28% O2 and repeat ABGs at 15-30 mins. Aim to keep PaO2 > 8kPa and PaCO2 < 7.5 kPa

Ventilatory failure

Where there is ventilatory failure, consider early ventilation

If ventilation is impractical or contraindicated, consider the use of a respiratory simulant eg doxapram

Treat bronchospasm

Treat as for acute asthma, including IV aminophylline and salbutamol

if CO2 retaining, nebulise using air (BUT if severely hypoxic give 2L oxygen by nasal cannulae simultaneously)

Urgent physiotherapy to clear bronchial secretions

Treat underlying infection with antibiotics

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