You decide to initiate therapy for patient with asthma exacerbation. Of the following options, the initial treatment is:
A) Subcutaneous epinephrine.
B) Albuterol MDI (metered-dose inhaler) with spacer.
C) Nebulized ipratropium.
D) Oral steroids.
E) IV steroids.
Discussion
The correct answer is B. The initial treatment for
this patient—and any patient presenting with an asthma exacerbation—is a
bronchodilator, in this case albuterol. It makes little difference whether this
is via nebulizer or MDI, as long as one uses adequate doses.
One albuterol nebulization is equal to about 8–10 puffs of an albuterol MDI
with a spacer. Answer A is incorrect because subcutaneous epinephrine is
second- or third-line treatment of asthma. Answer C is incorrect. While
ipratropium is effective in asthma, it is secondary to albuterol in the
treatment of asthma. Answers D and E are incorrect. Steroids are indicated, but
bronchodilator therapy is the primary treatment in acute asthma exacerbations.
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