Treatment
（1）Treatment of mild-exacerbation（wheezing，cough，prolonged expiration，normal speech，pulse＜110/min，respiratory.rate＜25/min）
①Salbutamol inhaler 2 puffs（=200 microgram）/60 min continue treatment for 1～3 hours f there is improvement.
②Prednisolone 40 mg od po.
（2）Treatment of Severe-exacerbation（can't complete sentence，pulse＞110 times/min，respiratory.rate＞25/min，chest retraction）
①Intravenous infusion.
②Oxygen saturation（SaO2）＞90%.
③Aerosol inhalation of salbutamol 5mg（1 mL）in 4 mL saline 30 minutes once for 3 times one day.
④Salbutamol inhaler+spacer device，2 puffs/10 min.
⑤Aerosol inhalation of ipratropium bromide，0.5 mg/30 min.
⑥Hydrocortisone 200 mg by intravenous infusion every 12 hours.
⑦Antibiotics are only used when it is complicated with infection.
（3）Life threatening exacerbation（silent chest，cyanosis，exhaustion，declining mental clarity，bradycardia）
①Be admit into ICU.
②Intravenous infusion.
③Oxygen therapy（until oxygen saturation＞90%）.
④Aerosol inhalation of ipratropium bromide，0.5 mg/10 min.
⑤Hydrocortisone 200 mg by intravenous infusion.
⑥Amoxycillin 500 mg，tid 5 day(https://www.daowen.com)
⑦Aminophylline 250 mg iv tid（slow infusion over 10～15 minutes，beware of seizures and arrhythmias）
⑧MgSO4 iv 2 g start（over 20 minutes）
⑨0.5～1.0 mg adrenaline of 1:1000 slowly nebulized or suction/drip.
⑩If there is no improvement：mechanical ventilation.
If good response select 3 states，discharge patient on inhaled steroids；continue beta-agonists inhaler；oral steroids for one week and follow up patient at the clinic.
Abbreviations
CXR（chest X ray）：胸片检查
cardiac USS，echocardiography：心脏B超
pulse-oximetry，Blood oxygen saturation of artery blood finger：脉搏-血氧饱和度
peak flow meter：最大呼气流量计
serum lactate：乳酸盐
ART（aortic regurgitation treatment）：主动脉返流治疗
greater than：大于
less than：小于
equal to/Be worth：等于
multiply by：乘以
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