Asthma and chronic obstructive pulmonary disease in the intensive care unit

There are many pitfalls in the management of patients with asthma or chronic obstructive pulmonary disease, especially when their condition becomes severe enough to warrant intensive care. Mortality in both groups remains significant. Standard principles of oxygen and drug administration and mechanical ventilation technique used for typical critically ill patients can all cause problems in this patient group. Recognition of the presence of airflow obstruction, the potential for dynamic hyperinflation and careful adherence to the principles of therapy specific to this group are required to avoid complications. This article addresses the physiological derangements in airflow obstruction, their treatment consequences and how to avoid the management pitfalls that are important contributors to the morbidity and mortality of both conditions.