Key messages

• Controlled oxygen therapy is used to increase PaO2 to 8 kPa without carbonarcosis.

• Beta-2 agonists and ipratropium bromide are combined in aerosolized form.

• Corticosteroid is administered only to known 'responders' or patients already taking corticosteroids.

• Aminophylline, respiratory stimulants, and digitalis are of little use.

• Consider an early trial of non-invasive ventilation (pressure support preferred).

• In acute life-threatening situations (respiratory arrest, cardiovascular collapse) or deterioration despite treatment, resort to intubation and controlled mechanical ventilation.

• Pitfalls of mechanical ventilation are alkalosis, air trapping ('intrinsic' positive end-expiratory pressure), barotrauma, and difficult and protracted weaning.

• During difficult weaning, always consider factors contributing to respiratory muscle fatigue.

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