Question

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

Hint:

Severe asthma needs a fast bronchodilator plus a steroid given quickly, not just one of the two.

Answer 1

The Correct Option is D

Step 1: Understanding the Question:
This boy has a known history of bronchial asthma (a disease where the airways narrow and become inflamed, causing wheeze and breathlessness), and he now shows a fast breathing rate of 48 per minute, pulsus paradoxus (an exaggerated drop in blood pressure while breathing in, a sign of severe airway obstruction), and rhonchi (wheeze like sounds) on both sides. Together these point to a severe acute asthma exacerbation, not a mild attack.

Step 2: Key Formula or Approach:
Severe acute asthma is treated on two fronts at the same time: a fast acting bronchodilator to open the airway right away, and a corticosteroid to bring down the airway inflammation, because the inflammation is what keeps the attack going and makes it come back if untreated.

Step 3: Detailed Explanation:
Nebulized salbutamol is the first line fast acting bronchodilator in an acute asthma attack; it works within minutes by relaxing the muscle around the airway.
Alongside it, a corticosteroid is needed, and in a severe attack this should be given intravenously so it acts quickly and reliably, rather than waiting for an oral dose to be absorbed.
Option (a), intravenous theophylline and corticosteroids, leaves out an inhaled bronchodilator, and theophylline is no longer used as first line therapy because of its narrow safety margin and drug interactions.
Option (b), intravenous theophylline and nebulized salbutamol, again brings in theophylline instead of a steroid, so it fails to address the ongoing airway inflammation.
Option (c), nebulized salbutamol and ipratropium, gives two bronchodilators together (ipratropium is an anticholinergic bronchodilator, often added in severe attacks) but still skips the corticosteroid, which is essential in a severe exacerbation like this one.
Option (d), nebulized salbutamol and intravenous corticosteroids, covers both needs at once: quick bronchodilation plus quick control of inflammation, matching current asthma exacerbation management.

Step 4: Final Answer:
\[ \boxed{\text{Nebulized salbutamol and intravenous corticosteroids}} \]