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Difficulty: EasyPulmonary and Critical Care

A 24-year-old woman presents to the emergency department with a 2-day history of progressively worsening shortness of breath, chest tightness, and a nonproductive cough. She has a history of asthma and normally uses an albuterol inhaler as needed, but she ran out of medication two weeks ago. Her temperature is 37.1 C (98.8 F), blood pressure is 128/82 mm Hg, pulse is 118/min, and respiratory rate is 28/min. Oxygen saturation is 93% on room air. Physical examination reveals diffuse bilateral expiratory wheezing with a prolonged expiratory phase. She is speaking in short phrases, using accessory muscles of respiration, and appears anxious. Which of the following are appropriate initial pharmacological interventions for this patient? (Select all that apply)

  1. Inhaled albuterolAnswer
  2. Oral prednisoneAnswer
  3. Inhaled ipratropiumAnswer
  4. D
    Intravenous furosemide
  5. E
    Intravenous levofloxacin

Answer

Inhaled albuterol, oral prednisone, and inhaled ipratropium
The patient is experiencing a moderate-to-severe acute asthma exacerbation. The standard initial management in the emergency department consists of inhaled short-acting beta-agonists (albuterol), inhaled short-acting anticholinergics (ipratropium), and early administration of systemic corticosteroids (such as oral prednisone). This combination rapidly relieves bronchospasm and addresses the underlying airway inflammation.

Step-by-Step Solution

1
Identify the primary diagnosis and assess severity.
The patient is experiencing a moderate-to-severe acute asthma exacerbation, evidenced by tachypnea, tachycardia, accessory muscle use, and difficulty speaking in full sentences.
Accurate severity assessment dictates the aggressiveness of the initial treatment bundle in the emergency department.
2
Select the appropriate initial bronchodilator therapy.
Inhaled albuterol and inhaled ipratropium should be administered immediately via nebulizer or metered-dose inhaler.
These agents work rapidly and synergistically to reverse acute bronchoconstriction.
3
Determine the need for systemic anti-inflammatory therapy.
Systemic corticosteroids (such as oral prednisone or intravenous methylprednisolone) should be given.
Corticosteroids treat the underlying airway inflammation, speed clinical recovery, and reduce the risk of hospital admission or relapse.

Key Concept

The standard initial pharmacological management of a moderate-to-severe asthma exacerbation in the emergency department includes inhaled short-acting beta-agonists, inhaled short-acting muscarinic antagonists, and systemic corticosteroids.
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Topics

Pulmonary and Critical Care

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