Therapy

Give beta-2 agonist or ipratropium nebulisers ^d

Give antibiotics ^a 

Consider any of

• a second-generation cephalosporins (e.g. ceftibuten)  ^a
• co-amoxiclav  ^a  
• a quinolone  ^a  
• a macrolide   ^a  

Give systemic steroids ^a  

Consider aminophylline ^a in severe cases ^d

• tachypnoea: rate > 23 per minute
• pH 7.25 to 7.35 with pCO₂ > 6 kPa

Arrange for intubation for patients with 

• pH < 7.20  ^a
• pH 7.20 to 7. 25 on 2 occasions 1 hour apart  ^a
• hypercapnic coma (GCS < 8 and pCO₂ > 8 kPa) ^d
• pO₂ < 6 kPa despite maximum tolerated FiO₂ ^d
• cardiorespiratory arrest ^a

There is no clear benefit from

• doxapram ^d  
• heliox ^d  
• adding ipratropium to beta-agonists ^d   
• magnesium sulphate ^d  
• chest physiotherapy ^d