Emergency Management of Central Airway Obstruction — SCE Palliative Medicine MCQ

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ModerateRespiratory SymptomsEmergency Management of Central Airway ObstructionSCE Palliative Medicine

A 70‑year‑old man with advanced lung cancer develops sudden‑onset stridor with respiratory distress. CT shows a large endobronchial tumour obstructing the left main bronchus. He is not a candidate for bronchoscopic intervention. What immediate pharmacological management may provide temporary relief?

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Correct answer: A — Nebulised adrenaline (1 mg of 1:1000 solution) for mucosal vasoconstriction, IV or SC dexamethasone 8–16 mg for peri‑tumoural oedema reduction, and heliox if available — plus anxiolysis

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

In malignant central airway obstruction causing stridor where intervention is not possible, temporising pharmacological measures are indicated. Nebulised adrenaline (1 mg of 1:1000) produces mucosal vasoconstriction and rapid reduction of airway oedema (supported by Scottish emergency/ENT guidance) ([rightdecisions.scot.nhs.uk](https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/palliative-emergencies/stridor/?utm_source=openai)). Dexamethasone (8–16 mg IV/SC or oral) reduces peri‑tumoural inflammation and oedema; rapid symptomatic benefit is described in UK palliative‑care protocols ([rightdecisions.scot.nhs.uk](https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/palliative-emergencies/stridor/?utm_source=openai)). Heliox (if available) improves laminar flow in narrowed airways and provides a bridge until steroids take effect – a standard emergency airway adjunct supported in UK emergency practice. Anxiolysis (e.g., midazolam) alleviates distress and prevents agitation which may worsen airway compromise. Other options are inappropriate: antibiotics (B) are irrelevant without infection; salbutamol (C) and aminophylline (D) target bronchospasm, not fixed mechanical obstruction; and option E is incorrect as temporising pharmacotherapy is indicated and endorsed in UK guidelines.

Reference: Scottish Palliative Care Guidelines – Stridor; Breathlessness (Right Decisions) (2026), NHS Borders Acute Upper Airway Obstruction guideline (2026), https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/palliative-emergencies/stridor/