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Case presentation
A 24-year-old woman presents to the emergency department complaining of cough, wheeze and difficulty breathing. Her symptoms began three days ago after she developed a cold. PMH. She has suffered from asthma since childhood. DH. She normally takes salbutamol inhaler 100 micrograms as required and beclometasone inhaler 400 micrograms daily. Treatment with high-flow oxygen has already been started by nursing staff. FH. Nil relevant. SH. She is a lifelong non-smoker.
On examination
She appears distressed and is unable to complete full sentences because of breathlessness. Temperature 37.5°C, HR 108/min and regular, BP 133/85 mmHg, RR 27/min, O2 sat 93% on high-flow oxygen, PEFR 190 L/min (predicted 439 L/min). She is using her accessory muscles to breathe. There is widespread wheeze on auscultation of the chest.
Investigations
Normal haematology and serum biochemistry. Arterial blood gases show PO2 9.6 kPa (11.3-12.6), PCO2 5.4 kPa (4.7-6.0) and pH 7.38 (7.35-7.45). ECG shows sinus tachycardia. Normal CXR.
