Course 04: Respiratory Medicine and Infectious Disease
Lesson 3 of 14. Explore the diagnostic and management frameworks, work through the case, and finish the linked 10-question practice set. Urgent presentations require an emergency-care pathway and review of local professional scope.
Risk stratification
- Severe distress, accessory muscle use, inability to complete sentences, agitation/drowsiness, low peak flow, cyanosis or silent chest indicate high risk.
- In a patient initially hyperventilating, normal or rising PaCO2 with severe work of breathing may indicate fatigue and impending ventilatory failure.
- Check for anaphylaxis, pneumonia, pneumothorax, PE, foreign-body aspiration and other dangerous mimics.
Immediate stabilization principles
- Activate emergency care for severe asthma; clinicians trained in acute care use rapid inhaled bronchodilators, oxygen according to need and early systemic corticosteroids.
- Add inhaled anticholinergic therapy and consider IV magnesium sulfate in severe or poorly responsive exacerbations in a supervised emergency setting.
- Impending arrest, reduced consciousness, exhaustion or failure to improve requires airway/critical-care support; do not postpone escalation for a chest film or routine labs.
Medicines and clinical safety
- Avoid sedative medications that could worsen ventilation in an unstable patient; repeated nebulizers or beta-agonists may affect potassium and heart rate.
- Anaphylaxis with bronchospasm is treated immediately with intramuscular epinephrine; asthma therapy must not replace epinephrine when anaphylaxis is suspected.
- Routine antibiotics are not indicated for an asthma exacerbation without convincing bacterial infection.
Discharge and prevention
- After stabilization, verify inhaler access, ICS-based controller plan, trigger management, inhaler technique, action plan and timely clinical review.
- Document the severity, response, systemic steroid exposure and any ICU or ventilation history; prior near-fatal attacks markedly increase future risk.
- A patient who remains hypoxemic, symptomatic at rest or unable to manage at home needs higher-level care rather than routine outpatient discharge.
Applied clinical case
A 19-year-old with severe wheezing becomes quieter, confused and exhausted. SpO2 is falling and PaCO2 has increased from low to normal.
Show model clinical reasoning and disposition
This may indicate life-threatening asthma with fatigue and impending respiratory failure; initiate emergency escalation for airway and critical-care support rather than being reassured by quieter wheeze or a normal PaCO2.
Clinical self-check
- Why can less wheezing indicate deterioration?
- Which accompanying signs require emergency transfer?
- What must be completed at discharge?
Current guidance and further learning
- GINA 2026: Asthma strategy and summary guide (external)
- Surviving Sepsis Campaign 2026 adult guideline (external)