Simple can be harder -

 Simple can be harder than complex.
You have to work hard to get your thinking clean.

—Steve Jobs

Double ABC of Worsening COPD

 Accessory muscle use increased

 Alertness reduced

 Bronchospasm increased

 Bronchodilator use increased

 Central Cyanosis worsened

 Cough/secretion worsened

 Dyspnea increased

 Decreased SpO2

 Edema increased peripherally

 Everyday activities limited

 Frequency cough increased 

 FiO2 need increased