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Level 4

Respiratory (drug use)


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Smoking cessation
COPD (reduce mortality)
Domiciliary oxygen
COPD (reduce mortality)
Short acting b2 agonist (as required)
COPD (symptom control, first line)
Short acting muscarinic antagonist
COPD (symptom control, first line)
Long acting b2 agonist
COPD (symptom control, second line)
Long acting muscarinic antagonist
COPD (symptom control, second line)
Inhaled corticosteroid
COPD (symptom control, second line if FEV1 < 50%)
B2A + MA + ICS
COPD (symptom control, third line)
High dose short acting bronchodilators
acute exacerbation of COPD
Oral steroids
acute exacerbation of COPD
Oxygen therapy (carefully)
acute exacerbation of COPD
NIV (noninvasive positive pressure ventilation)
acute exacerbation of COPD (ongoing respiratory acidosis despite treatment)
Short acting b2 agonist (as required)
asthma (step 1)
SA-B2A + inhaled corticosteroid
asthma (step 2)
SA-B2A + ICS + long acting B2A
asthma (step 3)
SA-B2A + high dose ICS + LA-B2A + regular bronchodilators
asthma (step 4)
SA-B2A + HD-ICS + LA-B2A + BD + oral corticosteroids
asthma (step 5)
Oxygen therapy (to sats of 94-98%)
acute severe asthma
Nebulised bronchodilators
acute severe asthma
Corticosteroids (PO, IM or IV)
acute severe asthma
IV fluid
acute severe asthma
IV magnesium sulphate
acute severe asthma (second line)
IV aminophylline
acute severe asthma (second line)