Question

A 74-year-old man with COPD presents with increased breathlessness, purulent sputum and wheeze. Baseline FEV1 is 45 percent predicted. On arrival he is using accessory muscles, respiratory rate 26 breaths per minute, oxygen saturations 88 percent on air, BP 138/82 mmHg, pulse 104 beats per minute. What is the most appropriate initial pharmacological management in the emergency department?

Accepted Answer

Nebulised Salbutamol and Ipratropium plus controlled oxygen aiming saturations 88–92 percent, with oral or intravenous steroids

Answer

High-flow oxygen to achieve saturations 100 percent without bronchodilators

Answer

Intravenous Frusemide and high-dose Morphine

Answer

Immediate non-invasive ventilation with no bronchodilators

Answer

Oral Doxycycline alone

Practice question