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Acute severe asthma — DipIMC MCQ

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HardMedical EmergenciesAcute severe asthmaDipIMC

A 20-year-old with acute severe asthma remains breathless after repeated oxygen-driven salbutamol. He has SpO2 91% on air, peak flow 38% of best and no evidence of anaphylaxis. Which adjunct should be added while escalation continues?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Add nebulised ipratropium bromide and systemic corticosteroid

The best answer is “Add nebulised ipratropium bromide and systemic corticosteroid”. Acute severe asthma requires repeated short-acting beta2 agonist, oxygen, early systemic corticosteroid and addition of nebulised ipratropium. Montelukast and long-acting beta2 agonists are not immediate rescue treatment. Antibiotics require a separate indication, and sedatives may worsen ventilation or conceal exhaustion. Persistent hypoxaemia requires close monitoring and senior escalation.

Reference: BTS/SIGN British guideline on the management of asthma (SIGN 158): https://www.brit-thoracic.org.uk/document-library/guidelines/asthma/btssign-guideline-for-the-management-of-asthma-2019-sign-158/