Management of acute exacerbations of airways disease: advice for the non-respiratory physician

Article Figures & Data

Table 1.

Clinical features differentiating chronic obstructive pulmonary disorder and asthma

	Chronic obstructive pulmonary disorder	Asthma
Smoker or ex-smoker	Nearly all	Possibly
Symptoms under the age of 35 years	Rare	Often
Chronic productive cough	Common	Uncommon
Breathlessness	Persistent and progressive	Variable, often over short time periods
Night-time waking with breathlessness and/or wheeze	Uncommon	Common
Significant diurnal or day-to-day variability of symptoms	Uncommon	Common

Table 2.

Levels of severity of acute asthma attacks in adults⁶

Moderate acute asthma	Increasing symptoms PEFR >50–75% best or predicted No features of acute severe asthma
Severe acute asthma	Any one of the following: PEFR 33%–50% best or predicted Respiratory rate ≥25 breaths/min Heart rate ≥110 beats/min Inability to complete sentences in one breath
Life-threatening asthma	Any one of the following in a patient with severe asthma: Clinical signs Altered conscious level Exhaustion Arrhythmia Hypotension Cyanosis Silent chest Poor respiratory effort Measurements PEFR <33% best or predicted SpO₂ <92% on air PaO₂ <8 kPa on air ‘Normal’ PaCO₂ (4.6–6.0 kPa)
Near-fatal asthma	Raised PaCO₂ and/or requiring mechanical ventilation with raised inflation pressures

PaCO₂ = partial arterial pressure of carbon dioxide; PaO₂ = partial arterial pressure of oxygen; PEFR = peak expiratory flow rate; SpO₂ = oxygen saturation measured by a pulse oximeter.