Respiratory Emergencies | Part Three | Asthma & COPD

Obstructive Airway Diseases are Asthma (4-5%) and COPD: sometimes divided into emphysema and chronic bronchitis (20% of adult males). Contributing factors:

  • Stress
  • Infection
  • Exercise
  • Tobacco smoke can cause asthma and COPD
  • Allergens: food, animal dander, dust, mold, pollen Drugs: reactions to beta blockers
  • Occupational hazards: latex allergy

Pathophysiology of obstructive lung disease:

  • Smooth muscle spasm/bronchospasm: beta receptors respond to sympathetic stimulation >> bronchodilation. Beta blockers are bronchoconstrictors:
    • Aminophylline
    • Theodur
    • Somophylline, Elixophylline, Brethine
    • Proventil, Ventolin, Alupent, Albuterol
  • Mucus: cilia moves mucus out
  • Inflammation

Asthma: 8.9 million people have this acute airflow obstructive disease of the lower airway. Hypersensitive bronchial airways that are easily irritated >>bronchospasm >> limits movement of air >>increased mucus> swelling and edema >> inflammatory cell proliferation
Most common onset in children and young adults. 1/3 develop it before age 5, 1/3 of children outgrow it, adult onset asthma is usually persistent. ¼ diagnosed after age 50.



  • Extrinsic asthma: some specific outside substance causes bronchioles to narrow, more common in children
  • Intrinsic asthma: no substance identified as causing narrowing. More commonly adult onset

Triggers to Asthma Attack:

Respiratory infections

  • Allergens
  • Drugs
  • Irritants
  • Exercise
  • Emotions/Stress
  • Chemicals
  • Changes in environmental conditions

Status Asthmaticus: severe, prolonged asthma attack that does not respond to standard medications. Monitor closely, transport immediately

COPD: progressive and irreversible disease, marked by decreased inspiratory and expiratory capacity of the lungs. Usually a combination of bronchitis and emphysema. Caused by: copd

  • Overgrowth of airway mucus glands, excess mucus
  • Emphysema: destruction of the elastic walls of the alveoli (they trap air and eventually pop)
  • Airway has a marked resistance to air movement
  • Cor Pulmonale: Right Side heart failure due to effort required to love blood to diseased lungs
  • Major cause is cigarette smoking
  • Quiet sounding chest in a patient who is obviously short of breath is ominous -airways may be too tight to wheeze
  • CO2 Retainers: patient who have lost their CO2 drive to breath, low O2 (hypoxic) is their only drive to breathe. Quite unusual

Signs and symptoms:
Shortness of breath, 1-2 word dyspnea

Anxiety, feeling of suffocation, too tired to breath 
Altered LOC
Diaphoresis and pallor

Cigarette stains on fingers
Barrel chest
Use of accessory breathing muscles
Audible abnormal breath sounds
Decreased pulse ox (low 90s is good for COPDers) Neck vein distension
Leg edema

Management of COPD/Asthma

  • Intubate if: severe respiratory difficulty, cyanosis, BP <70
  • Or provide high flow O2 on a non-rebreather (85-100% O2) or nasal cannula
    • 6L/min (24-44%)
  • Transport upright, keep calm, don’t exert
  • Monitor vital signs, pulse ox, ECG
  • Treat bronchospasm with albuterol (beta 2 agonist) and/or epinephrine IV solution of normal saline or lactated Ringers or 5% dextrose in water
  • Transport priority patients

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