Asthmatic
patient responds to nebulizers and steroids in the emergency department. She
has been using her albuterol daily. You decide to send her home.
Which of the following is true?
A) You should discharge the patient on 2 puffs of an albuterol MDI via spacer to be used PRN.
B) You should place the patient on a steroid taper.
C) You should discharge the patient on 8–10 puffs of an albuterol MDI via spacer to be used every 6 hours around the clock.
D) You should start the patient on a steroid inhaler.
E) None of the above.
Which of the following is true?
A) You should discharge the patient on 2 puffs of an albuterol MDI via spacer to be used PRN.
B) You should place the patient on a steroid taper.
C) You should discharge the patient on 8–10 puffs of an albuterol MDI via spacer to be used every 6 hours around the clock.
D) You should start the patient on a steroid inhaler.
E) None of the above.
Discussion
The correct answer is D. The patient should be started on a steroid inhaler to prevent recurrent exacerbations. She has been using her albuterol daily, indicating poor control. Overlapping this with oral steroids will give the inhaled steroid a chance to work while the patient is being covered with the oral steroids. Answer A is incorrect. The proper dose of albuterol via MDI is 6–10 puffs PRN. Answer B is incorrect because patients do not need a steroid taper if they are not on chronic steroids and will be taking steroids for no more than 10 days. You can simply treat the patient (eg, with prednisone 40 mg PO QD for 5–10 days) and then stop. No taper is needed. Note that this is not true for patients on chronic steroids who clearly do need a taper. Answer C is incorrect because scheduled albuterol is not as effective as PRN use. Additionally, albuterol can certainly be used more than every 6 hours.
The correct answer is D. The patient should be started on a steroid inhaler to prevent recurrent exacerbations. She has been using her albuterol daily, indicating poor control. Overlapping this with oral steroids will give the inhaled steroid a chance to work while the patient is being covered with the oral steroids. Answer A is incorrect. The proper dose of albuterol via MDI is 6–10 puffs PRN. Answer B is incorrect because patients do not need a steroid taper if they are not on chronic steroids and will be taking steroids for no more than 10 days. You can simply treat the patient (eg, with prednisone 40 mg PO QD for 5–10 days) and then stop. No taper is needed. Note that this is not true for patients on chronic steroids who clearly do need a taper. Answer C is incorrect because scheduled albuterol is not as effective as PRN use. Additionally, albuterol can certainly be used more than every 6 hours.
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