8‏/12‏/2016

MCQ 6 (Medicine/Asthma/initial therapy in asthma exacerbation

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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