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Acute asthma exacerbation — MCCQE Part 1 MCQ

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ModerateWheezingAcute asthma exacerbationMCCQE Part 1

A 22-year-old student with asthma presents with severe wheeze after a viral illness. She speaks in short phrases, peak expiratory flow is 38% predicted and oxygen saturation is 91%. Which of the following is the most appropriate next step?

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Correct answer: A — Give oxygen, repeated inhaled salbutamol plus ipratropium, and systemic corticosteroids

Severe asthma exacerbation requires immediate oxygen, frequent short-acting bronchodilators, ipratropium in severe attacks and systemic corticosteroids. Antibiotics are not routine without bacterial features, and spirometry should not delay treatment in an acute severe attack. Controller optimization matters after stabilization, but it is not sufficient as acute treatment.

Reference: Canadian Thoracic Society asthma guidance; Choosing Wisely Canada respiratory recommendations