Abstract
Acute respiratory insufficiency due to obstructive pulmonary diseases is a common problem presenting to the emergency medical service. Most frequent causes are acute asthma attacks or acute exacerbations of chronic obstructive pulmonary disease (COPD). In the prehospital setting the improvement of oxygenation is most important. Beyond oxygen inhalation, the use of inhaled ß2-agonist and systemic corticosteroids should be the first step in pharmacological management of asthma and COPD. Further options are the administration of inhaled anticholinergic drugs, magnesium, and methylxanthines. In failure of pharmacological treatment, techniques of mechanical ventilatory support should be considered. Especially in patients with acute exacerbation of COPD, non-invasive ventilation (NIV) has been shown to be an effective adjunct to standard medical therapy. The role of non-invasive ventilation in patients with acute asthma, especially in children, is needed to determine.
