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 unit level 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. Recognition of the presence of airflow obstruction, the potential for dynamic hyperinflation and careful alteration of the principles and targets of therapy are required to avoid complications. In this article we examine the nature and scope of the challenge facing intensivists, highlighting difficulties in management and outlining specific strategies to aid in managing both conditions.