Shortness of breath

68-year-old man from HOME, lives with spouse and uses 2 L/min home oxygen, reports two days of worsening dyspnea with productive cough. Denies chest pain, syncope or hemoptysis. COPD history; rescue inhaler gave minimal relief.

Primary survey shows increased work of breathing with patent airway. Patient found tripod-positioned on sofa, speaking 3–4 word sentences. RR 30, SpO₂ 84% on usual oxygen, HR 112; bilateral wheeze with reduced air entry. Temperature 38.2 °C.

Differential considerations: 1) acute COPD exacerbation, 2) lower respiratory infection or pneumonia, 3) acute heart failure. Moderate respiratory distress with hypoxemia.

Oxygen and bronchodilator therapy provided per applicable guideline. Continuous monitoring and serial reassessment performed; SpO₂ improved to 91%, RR to 24 and speech length increased. Transported to ED with baseline oxygen, findings and response handed over.