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Acute Asthma Exacerbation — MRCEM SBA MCQ

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EasyRespiratory MedicineAcute Asthma ExacerbationMRCEM SBAMRCGP AKTUKMLAPARA

A 25-year-old with known asthma presents to a GP surgery with an acute exacerbation. Their peak expiratory flow is 45% of their personal best, respiratory rate is 26 breaths/min and oxygen saturation is 94% on air. They can speak in sentences. Which bronchodilator treatment should be administered first?

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Correct answer: E — Nebulised salbutamol 5 mg, preferably oxygen-driven

This is acute severe asthma because either a PEF of 33–50% of best or predicted or a respiratory rate of at least 25/min is sufficient; the ability to speak in sentences does not downgrade the attack. High-dose inhaled short-acting beta-2 agonist therapy should be given immediately. For acute severe asthma, salbutamol 5 mg by an oxygen-driven nebuliser is preferred; a pMDI with spacer may be used if nebulisation is unavailable. Oral prednisolone 40–50 mg should also be given early, but not instead of bronchodilation. Ipratropium is an adjunct rather than appropriate monotherapy. Intravenous magnesium is reserved for severe or life-threatening attacks responding poorly to initial inhaled therapy. Inhaled budesonide does not provide sufficiently rapid bronchodilation.

Reference: Resuscitation Council UK. Quick Reference Handbook, section 3-3: Asthma. March 2022. https://www.resus.org.uk/sites/default/files/2022-07/RCUK%20QRH%20complete%20March%202022%20-%20final.pdf