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Drug-triggered bronchospasm — DipIMC MCQ

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ModerateMedical EmergenciesDrug-triggered bronchospasmDipIMC

A 68-year-old man becomes acutely breathless and wheezy after starting a new beta-blocker. He is speaking in words, oxygen saturations are 89%, pulse 118 and peak flow is less than 40% of his best. What is the most appropriate drug/dose?

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Correct answer: A — Nebulised salbutamol 5 mg with oxygen and urgent escalation

Severe bronchospasm with hypoxaemia requires oxygen-driven nebulised bronchodilator and urgent escalation. Glucagon may have a role in beta-blocker toxicity with bradycardia or shock, but it is not the sole first-line treatment for this severe asthma-like presentation. Sedating cough suppressants can worsen respiratory failure. The pearl is that drug triggers should be recognised without delaying standard acute asthma care.

Reference: JRCALC Guidelines 2025; BTS/SIGN Asthma Guidance