A 9-year-old boy with a history of mild persistent asthma presents to the emergency depart… — USMLE Step 2 CK

A 9-year-old boy with a history of mild persistent asthma presents to the emergency department with a 24-hour history of worsening cough, shortness of breath, and chest tightness. He recently had symptoms of a mild viral upper respiratory tract infection. Vital signs show a temperature of $37.2^\circ\text{C}$ ( $99.0^\circ\text{F}$ ), heart rate of $115/\text{min}$ , respiratory rate of $28/\text{min}$ , and oxygen saturation of $94\%$ on room air. Physical examination reveals mild intercostal retractions and diffuse expiratory wheezing bilaterally. Which of the following are appropriate initial steps in the management of this patient's condition? (Select all that apply)

Administration of nebulized albuterolAnswer
Administration of oral prednisoneAnswer
C
Prescription of oral amoxicillin-clavulanate
D
Administration of nebulized hypertonic saline
E
Administration of intravenous furosemide

Answer

The correct initial steps are the administration of nebulized albuterol and the administration of oral prednisone.

The correct options involve standard, evidence-based initial therapy for an acute asthma exacerbation. Nebulized albuterol provides rapid bronchodilation via smooth muscle relaxation, and oral prednisone acts systemically to decrease acute airway inflammation, which is the underlying pathophysiological mechanism of the exacerbation.

Step-by-Step Solution

Identify the patient's clinical presentation.

The patient is experiencing an acute asthma exacerbation, likely triggered by a recent viral upper respiratory infection, presenting with tachypnea, retractions, and diffuse wheezing.

Recognizing the acute exacerbation pattern is necessary to prioritize immediate bronchodilation and anti-inflammatory therapy.

Select the appropriate pharmacologic interventions for an acute asthma exacerbation.

Albuterol (a short-acting beta-2 agonist) and systemic corticosteroids (such as prednisone) are selected.

Albuterol rapidly reverses acute bronchospasm, while systemic corticosteroids address the underlying airway inflammation and reduce the risk of future relapses.

Key Concept

The initial management of acute asthma exacerbations in children requires rapid reversal of bronchospasm with short-acting beta-agonists and reduction of airway inflammation with systemic corticosteroids.

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