CASE 3: ACUTE ASTHMA
Q.C., a 5-year-old 18 kg female, presents to the ER with
complaints of dyspnea and coughing that have progressively
worsened over the past 2 days. The symptoms were preceded by
3 days of symptoms of a viral upper respiratory tract infection
(sore throat, rhinorrhea, and coughing).
She has experienced several bouts of bronchitis in the last 2
years, was hospitalized for pneumonia 3 months ago. Q.C. is not
being treated with any medication at the present time. Physical
examination reveals an anxious appearing young girl in
moderate respiratory distress with audible expiratory wheezes,
occasional coughing, a prolonged expiratory phase, a
hyperinflated chest, and suprasternal, supraclavicular, and
Bilateral inspiratory and expiratory wheezes with decreased
breath sounds on the left side are heard on ausculation. Q.C.’s
vital signs are: respiratory rate (RR) 30/min, blood pressure
(BP) 110/83 mm Hg, heart rate 130 beats/min temperature
37.8ºC, pulsus paradoxus 18 mm Hg.
Q.C. is given 2.5 mg of albuterol (Ventolin) as 0.5 mL of a 0.5%
solution in 2.5 mL of normal saline by a compressed air
nebulizer over 10 minutes. Following the treatment, Q.C. claims
some subjective improvement and appears to be more
comfortable; however, wheezing on auscultation becomes
1. What sign and symptoms in Q.C. are consistent with acute
2. What additional tests would be helpful in assessing the extent
of pulmonary obstruction in QC?
3. What signs, symptoms or laboratory measures of obstruction
can best predict whether Q.C will require hospitalization or
whether she will relapse and return to the ER if not
4. Why was a β2 agonist selected as a bronchodilators of first
choice in preference to other bronchodilators such as
aminophylline or atropine for Q.C
5. Why was the β2 agonist, albuterol, administered to Q.C by
nebulizer instead of the oral or parenteral routes of
6. Would another β2 agonist have been more effective
in the initial therapy of Q.C?
7. Q.C’s heart rate increase from 130 beat/mins at the
time of administration to 140 beat/min after her first
dose of aerosolized albuterol and her diastolic BP
decreased from 83 to 74 mmgH. Explain the change
in Q.C’s heart rate.