#0004

COPD exacerbation with type 2 respiratory failure

Patient

67y · Male

Date

25 Sept 2026

COPDNIV

Chief Complaint

Can't catch my breath, coughing green phlegm for 4 days

Clinical Case

age

67 years

sex

M

occupation

Retired factory worker

habits

smoking

45 pack-years, quit 2 years ago

Can't catch my breath, coughing green phlegm

Duration

4 days

History of Present Illness

onset

Gradual

course

Worsening

associated symptoms

  • Purulent sputum
  • Wheeze
  • Morning headache

Current Medications

  • Tiotropium 18 mcg daily
  • Salbutamol inhaler as needed

medical

COPD GOLD 3, two admissions this year

allergies

Penicillin (rash)

vitals

BP

145/85

HR

104

RR

30

TEMP

37.9

SPO2

84% on room air

general

Using accessory muscles, speaking in short phrases

systemic

resp

Hyperinflated chest, widespread wheeze, reduced air entry at bases

labs

  • ABG: pH 7.29, PaCO₂ 68 mmHg, PaO₂ 52 mmHgOn arrival
  • CRP 64 mg/L

imaging

  • Chest X-ray: hyperinflation, no consolidation or pneumothorax

primary diagnosis

Infective exacerbation of COPD with acute hypercapnic respiratory failure

differentials

  • Community-acquired pneumonia
  • Pulmonary embolism

medications

  • Nebulised salbutamol + ipratropiumEvery 4 hours
  • Prednisolone40 mg daily for 5 days
  • Doxycycline100 mg daily (penicillin allergy)

procedures

  • Non-invasive ventilation (BiPAP 18/6)Day 1

follow up

Pulmonary rehab referral; review home oxygen at 6 weeks