Neisseria meningitidis plated on blood agar

Question.

A 34 years old lady is admitted with a diagnosis of severe asthma. She has a long history of asthma with multiple hospitalizations for severe asthmatic attacks. Three days prior to admission she has moved to a newly refurbished house. Ever since then she has had a progressively worsening shortness of breath. She is nauseas and has vomited three times today. Salbutamol and Ipratropium bromide nebulizer treatments did not relieve her symptoms. Her peak flow rate has decreased by nearly 50% from baseline.

What should be the next step in the patient’s treatment be to relieve her symptoms?

        1. Terbutaline sulfate
        2. Beclomethasone
        3. Prednisolone
        4. Hydrocortisone
        5. Disodium cromoglycate

    Answer.

    4. Hydrocortisone 

     
    Explanation.

    Adding an IV steroid will augment the action of the bronchodilators by reducing inflammation surrounding the airways.

    Terbutaline sulfate: is a beta-adrenergic receptor agonist which can be given as an alternative to Salbutamol to reverse bronchospasm.

    Beclomethasone: A surface acting steroid dispensed in aerosolized form. It is used in the long-term treatment of chronic asthma to prevent recurrent attacks. It can not be used for acute attacks.

    Prednisolone: In this scenario since the patient has history of recent vomiting, she will not be able to take oral prednisolone. A parentral hydrocortisone or intramuscular methylprednisolone are better alternatives.

    Disodium cromoglycate: is a mast cell stabilizer used to decrease the occurrence and severity of asthma attacks. Once bronchospasm is established it has little use.