Question:medium
A 5-year old boy, a known patient of bronchial asthma, presents with cough, wheezing and breathlessness. Examination shows respiratory rate 48 per minute, pulsus paradoxus, and bilateral rhonchi. The most appropriate immediate treatment is
A 5-year old boy, a known patient of bronchial asthma, presents with cough, wheezing and breathlessness. Examination shows respiratory rate 48 per minute, pulsus paradoxus, and bilateral rhonchi. The most appropriate immediate treatment is
Show Hint
Severe asthma needs a fast bronchodilator plus a steroid given quickly, not just one of the two.
Updated On: Jul 7, 2026
- Intravenous theophylline and corticosteroids
- Intravenous theophylline and nebulized salbutamol
- Nebulized salbutamol and ipratropium
- Nebulized salbutamol and intravenous corticosteroids
Show Solution
The Correct Option is D
Solution and Explanation
Step 1: Understanding the Concept:
A child with known asthma who now breathes 48 times a minute, shows pulsus paradoxus, and has wheeze on both sides of the chest is having a severe attack. This combination of signs tells us the airway narrowing this time is serious, not a mild wheeze that will settle on its own.
Step 2: Key Formula or Approach:
Two separate problems need fixing together in a severe attack: the airway muscle is squeezed tight (needs a bronchodilator to relax it fast), and the airway lining is inflamed and swollen (needs a corticosteroid to calm it down, since this is what keeps the attack going).
Step 3: Detailed Explanation:
Nebulized salbutamol delivers the bronchodilator straight into the lungs where it is needed, giving quick relief of the muscle spasm. A corticosteroid given intravenously acts faster and more reliably than an oral tablet in this urgent setting, and it treats the swelling and inflammation that a bronchodilator alone cannot fix.
The theophylline based options are outdated choices; theophylline has a narrow safe dose range, can cause dangerous side effects, and is no longer standard therapy, and neither of those two options includes a steroid at all.
The option pairing salbutamol with ipratropium gives two bronchodilators, which can help in a severe attack, but it still misses the steroid, so the swelling driving the attack is left untreated.
Only the pairing of nebulized salbutamol with intravenous corticosteroids treats both the squeezed muscle and the swollen lining together, exactly what a severe exacerbation needs right away.
Step 4: Final Answer:
\[ \boxed{\text{Nebulized salbutamol and intravenous corticosteroids}} \]
A child with known asthma who now breathes 48 times a minute, shows pulsus paradoxus, and has wheeze on both sides of the chest is having a severe attack. This combination of signs tells us the airway narrowing this time is serious, not a mild wheeze that will settle on its own.
Step 2: Key Formula or Approach:
Two separate problems need fixing together in a severe attack: the airway muscle is squeezed tight (needs a bronchodilator to relax it fast), and the airway lining is inflamed and swollen (needs a corticosteroid to calm it down, since this is what keeps the attack going).
Step 3: Detailed Explanation:
Nebulized salbutamol delivers the bronchodilator straight into the lungs where it is needed, giving quick relief of the muscle spasm. A corticosteroid given intravenously acts faster and more reliably than an oral tablet in this urgent setting, and it treats the swelling and inflammation that a bronchodilator alone cannot fix.
The theophylline based options are outdated choices; theophylline has a narrow safe dose range, can cause dangerous side effects, and is no longer standard therapy, and neither of those two options includes a steroid at all.
The option pairing salbutamol with ipratropium gives two bronchodilators, which can help in a severe attack, but it still misses the steroid, so the swelling driving the attack is left untreated.
Only the pairing of nebulized salbutamol with intravenous corticosteroids treats both the squeezed muscle and the swollen lining together, exactly what a severe exacerbation needs right away.
Step 4: Final Answer:
\[ \boxed{\text{Nebulized salbutamol and intravenous corticosteroids}} \]
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