Acute Asthma — ORE Part 1 MCQ

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EasyPharmacology & TherapeuticsAcute AsthmaORE Part 1

An asthmatic patient becomes acutely breathless with audible wheeze during a dental appointment. They have their reliever inhaler with them. What is the most appropriate initial management?

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Correct answer: C — Administer salbutamol 2–4 puffs via spacer device and sit the patient upright

The correct answer is C. Acute asthma in the dental setting is a medical emergency requiring immediate first-line bronchodilator therapy. Salbutamol (a short-acting β₂ agonist) administered via a metered-dose inhaler with a spacer device ensures optimal lung delivery and rapid bronchial smooth muscle relaxation. 2–4 puffs is the standard acute-attack dose. Upright positioning optimizes thoracic mechanics and gas exchange. This approach is mandated by NICE/BTS/SIGN respiratory guidelines and SDCEP dental emergency protocols. Option E (IM adrenaline) is for anaphylaxis, not asthma. Option A delays essential treatment contrary to guidance. Option D (low-flow oxygen) is supportive only and subtherapeutic; oxygen is added after bronchodilator relief if hypoxia persists. Option B (ipratropium) is an anticholinergic agent reserved for severe exacerbations in hospital as an adjunct, not monotherapy in dental practice.

Reference: NICE Asthma pathway: Managing acute asthma (2024), British Thoracic Society/SIGN British guideline on the management of asthma (SIGN 158, amended 2024), and SDCEP Practice Support Manual on medical emergencies in dental practice. https://www.nice.org.uk/guidance/ng244 and https://www.sign.ac.uk/guidelines/british-guideline-on-the-management-of-asthma/