Question

A 5-year old boy, a known patient of bronchial asthma, presents with cough, wheezing and breathlessness. Examination shows respiratory rate 48/minute, pulsus paradoxus and bilateral rhonchi. The most appropriate immediate treatment is

• A. Intravenous theophylline and corticosteroids
• B. Intravenous theophylline and nebulized salbutamol
• C. Nebulized salbutamol and ipratropium
• D. Nebulized salbutamol and intravenous corticosteroids

Hint:

Acute severe asthma needs fast inhaled bronchodilation plus early systemic steroid, not intravenous theophylline.

Answer 1

The Correct Option is D

This child's fast breathing, pulsus paradoxus, and bilateral rhonchi on top of known asthma point straight to an acute severe asthma attack. Let's weigh each treatment option against what current asthma guidelines recommend as the first move.

1. Intravenous theophylline and corticosteroids: theophylline has a narrow safety window and easily causes vomiting, arrhythmia, or seizures, so it is no longer used as first-line therapy even though the corticosteroid part is correct.
2. Intravenous theophylline and nebulized salbutamol: nebulized salbutamol is right, but pairing it with theophylline instead of a corticosteroid still carries the same theophylline safety concern and skips the needed anti-inflammatory drug.
3. Nebulized salbutamol and ipratropium: both are good inhaled bronchodilators and often used together in severe attacks, but this pairing alone does not include a corticosteroid, which is needed to control the airway inflammation driving the attack.
4. Nebulized salbutamol and intravenous corticosteroids: this gives fast bronchodilation along with early anti-inflammatory treatment, matching exactly what guidelines recommend for an acute severe asthma attack.

The fourth option covers both jobs, opening the airway quickly and calming the inflammation, so it is the most appropriate immediate treatment.

Let's summarize:

• Nebulized salbutamol is the fast bronchodilator of choice in an acute attack.
• Systemic corticosteroids must be started early to control inflammation.
• Intravenous theophylline is avoided as first-line therapy due to its narrow safety margin.

So the best immediate treatment is nebulized salbutamol with intravenous corticosteroids.