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Asthma (Life-threatening) — UKMLA MCQ

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HardRespiratory MedicineAsthma (Life-threatening)UKMLAMRCP Part 1MRCEM SBAPARA

An adult with acute asthma remains unable to speak, has a silent chest and peak flow 25% predicted after oxygen, repeated nebulised beta-agonist/ipratropium and systemic corticosteroid. What pharmacological escalation is most appropriate?

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Correct answer: D — Single intravenous magnesium infusion with ongoing bronchodilator therapy

The best answer is “Single intravenous magnesium infusion with ongoing bronchodilator therapy”. Life-threatening acute asthma that responds poorly to intensive inhaled bronchodilators and corticosteroid warrants a single intravenous magnesium-sulfate infusion, continued first-line therapy and early senior/critical-care involvement. Magnesium can improve airflow in severe attacks and has a more favourable routine risk profile than aminophylline, which requires expert selection and monitoring. Subcutaneous beta-agonist is not standard first escalation, montelukast is too slow, and furosemide does not treat bronchospasm. Airway deterioration must be anticipated concurrently.

Reference: NICE NG244 acute asthma management: https://www.nice.org.uk/guidance/ng244/chapter/Managing-acute-asthma