Acute exacerbation of chronic obstructive pulmonary disease (COPD) or asthma represents a sudden and severe worsening of respiratory symptoms that can rapidly become life-threatening. These exacerbations are a common cause of ICU admission due to progressive airflow obstruction, respiratory muscle fatigue, carbon dioxide retention, and hypoxemia. Without timely ICU intervention, patients may develop respiratory failure requiring mechanical ventilation.

Exacerbations are often triggered by respiratory infections, environmental pollutants, medication non-adherence, or underlying cardiac conditions. Patients typically present with severe shortness of breath, wheezing, chest tightness, rapid breathing, anxiety, and altered consciousness. As airflow limitation worsens, carbon dioxide levels rise, leading to respiratory acidosis and further clinical deterioration.

ICU management focuses on rapid stabilization of breathing and correction of gas exchange abnormalities. High-flow oxygen therapy is carefully titrated to avoid worsening carbon dioxide retention. Non-invasive ventilation is frequently used to reduce the work of breathing and improve ventilation, while invasive mechanical ventilation is required in severe or refractory cases.

Bronchodilator therapy, systemic corticosteroids, and targeted antimicrobial treatment are administered promptly. Continuous monitoring of blood gases and respiratory mechanics allows ICU teams to assess response to therapy and adjust treatment accordingly. Sedation and airway protection may be necessary when respiratory distress becomes severe.

Exacerbations of COPD and asthma place significant strain on the heart and other organs. ICU care includes close monitoring for cardiac arrhythmias, hypotension, and secondary infections. Fluid management and nutritional support are optimized to aid recovery.

Patients recovering from severe exacerbations often require prolonged respiratory support and rehabilitation. ICU intervention not only saves lives but also helps prevent long-term decline in lung function and quality of life.