29th February 2024

A 61-year-old man is admitted to the emergency department with increasing shortness of breath and a dry cough.

He denies having any previous hospital admissions related to his breathing in the past.

He has received a dose each of nebulised salbutamol and ipratropium bromide, and has further doses prescribed.

PMHx. COPD, GORD, hypertension DH. Omeprazole 20 mg PO daily, Salbutamol 200 micrograms INH as required, budesonide with formoterol 2 inhalations twice daily, amlodipine 10 mg PO daily. NKDA. SHx. Current smoker of 20 cigarettes per day.

On examination

He is sat upright in bed with a 24% Venturi mask in-situ and is visibly short of breath at rest. He has a widespread expiratory wheeze on auscultation.

Temperature 36.7, HR 112 /min and rhythm regular, BP 145/72 mmHg, RR 32/min, O2 sat 84% on air

Investigations

The results of his arterial blood gas (ABG) are shown below:

pH 7.29 (7.35 – 7.45)

PaO2 8.8 (10.5 – 13.5 kPa)

PaCO2 7.1 (4.5 – 6.0 kPa)

HCO3 29 (22 – 26 mEq/L)

Select the most appropriate management option for this patient at this stage: