Study topic
Respiratory chronic disease
NCLEX COPD and asthma chapter: controlled oxygen, life-threatening asthma cues, rescue versus controller inhalers, and spacer technique.
Obstructive airway items ask two practical skills: give enough oxygen without harming a COPD retainer, and put the right inhaler in the right order when the client is tight and scared.
COPD and asthma under pressure
| Situation | Priority idea |
|---|---|
| COPD exacerbation, SpO2 low | Controlled O2 per order/target; upright position; nebulizers/meds as ordered; watch mentation and CO2 retention cues |
| COPD on unexpectedly high O2 becoming sleepy | Reassess oxygen; somnolence can signal rising CO2 |
| Severe asthma after treatment | Compare work of breathing, wheeze, SpO2, speech; silent chest/fatigue = escalate |
| Home COPD teaching | Stop smoking, vaccines, breathing techniques, infection warning signs |
Safety
If wheeze disappears while the asthmatic client becomes exhausted and quiet, treat that as deterioration, not improvement.
Inhalers: rescue, controller, technique
| Medicine role | Examples on exams | Job |
|---|---|---|
| Rescue / quick relief | Albuterol (SABA) | Acute bronchospasm |
| Controller / maintenance | Inhaled corticosteroid (fluticasone), montelukast | Prevent inflammation; not acute rescue |
- Shake the MDI as directed.
- Attach spacer; lips sealed on mouthpiece.
- Actuate once; inhale slowly and deeply.
- Hold breath briefly; wait between puffs as taught.
- If a steroid inhaler is also due, take the bronchodilator first, then the steroid; rinse mouth afterward.
- Expected albuterol effects can include tremor and tachycardia; chest pain or severe reaction is reportable.
- Thrush risk after inhaled steroids is why rinsing matters.
- Montelukast is taken regularly for control, not for sudden severe wheeze.
Priority map
| Picture | First move |
|---|---|
| COPD SpO2 86% | Controlled oxygen per protocol; upright; meds |
| Asthma + silent/exhausted | Emergency escalation |
| Albuterol + ICS both due | Bronchodilator first, then steroid, then rinse |
| Wrong spacer technique | Reteach seal, slow inhale, hold |
Must know
- 1COPD hypoxic drive teaching on exams: start controlled low-flow oxygen (often 1–2 L/min NC or target SpO2 per order, commonly around 88–92% when ordered that way). High uncontrolled O2 can worsen CO2 retention in some COPD clients.
- 2Asthma attack: give rescue bronchodilator first. Silent chest, extreme fatigue, or rising CO2/falling LOC means life-threatening asthma — escalate.
- 3Albuterol = rescue. Inhaled corticosteroid = controller. Use bronchodilator before steroid inhaler when both are due.
- 4MDI with spacer: shake, seal lips on spacer, actuate, slow deep inhale, hold breath briefly as taught, rinse mouth after steroid inhalers.
- 5COPD home teaching: smoking cessation, vaccines, pursed-lip/diaphragmatic breathing, pacing activity, report sputum/fever changes.
- 6Montelukast is a controller pathway agent (leukotriene), not a rescue for acute wheeze.
Memory hooks
Rescue before rinse
Open the airways with the rescue inhaler first, then take the inhaled steroid, then rinse the mouth.
Quiet chest is not calm chest
In severe asthma, loss of wheeze with exhaustion can mean air is barely moving. That is worse, not better.
Low and slow O2 in COPD
For many COPD exacerbations the exam expects controlled oxygen, not a casual 6 L jump without reassessment.
How it's tested
Stems ask which O2 to start for COPD at 86%, whether findings after asthma treatment are better or worse, inhaler order, or spacer steps. Distractors crank oxygen high without a plan, use the steroid inhaler for acute rescue, or skip mouth rinse after ICS.