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Junior doctor survival kit

Patient with shortness of breath

How to manage a patient who is experiencing an acute exacerbation of chronic obstructive pulmonary disease

By: Andrew Feneley, Andrew Clarke, Neil Goldsack

Patients presenting with shortness of breath can be a challenge because it is a common but non-specific symptom.1 Patients who experience breathlessness can have respiratory, cardiac, or renal disease, but it can also be caused by anxiety, sepsis, or neurological conditions. In this article we will use a fictitious case of a patient who becomes breathless during your on-call shift to help you decide how to prioritise urgent tasks.

A patient with breathlessness and a pre-existing respiratory disease could deteriorate quickly, so you should aim to prioritise Mr Ayre’s assessment. Agree a timeframe with Marie in which you will review Mr Ayre.

Mr Ayre has had COPD for five years and has been admitted to hospital for his COPD twice in the past year. Both times he had a course of oral steroids, but he never required artificial ventilation or admission to the intensive care unit. He normally copes well

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