Case presentation

A 72-year-old man with severe COPD (FEV1 38%) presents to ED with 3 days of increased dyspnoea, increased sputum volume and purulence. He is a current smoker. Home medications: Seretide 500 BD, tiotropium 18 mcg OD, salbutamol PRN. He has no drug allergies. ED observations: RR 28, SpO2 89% on 2L nasal cannulae, HR 104, BP 142/86. ABG (on 2L O2): pH 7.31, PaCO2 8.4 kPa, PaO2 8.0 kPa, HCO3 28. Chest auscultation: bilateral coarse crackles and wheeze. CXR: hyperexpanded lungs, no consolidation.

Observations / investigations

Task

Prescribe the single most appropriate immediate nebulised bronchodilator to relieve the acute bronchospasm, stating drug, dose, route and frequency.