Ahmad, a 36-year-old, is brought to your room by his wife Ibtesam. He is very breathless and is only able to speak in single words. Ibtesam tells you he has had asthma for years but she has noticed he has been taking his blue puffer more frequently lately, and for the last few hours he has been using it about every 15-20 minutes.

Question 4

Ahmad responds to salbutamol administered in a high dose by nebuliser. However he is still wheezing, but less severely, 15 minutes after commencing salbutamol. You now decide to admit Ahmad to hospital for ongoing management. Treatment is maintained during transport and continued in hospital.

Before leaving the clinic you write the following orders for the hospital staff to initiate before your arrival. Select from the following list those items which you wish to include unaltered.

	a. Administer intranasal oxygen.
	b. Administer salbutamol 3-4 hourly.
	c. Set up an intravenous line.
	d. Give IV hydrocortisone 250 mg.
	e. Arrange spirometry, and continue to monitor progress.

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Answer 4

e. Arrange spirometry, and continue to monitor progress - The authors agree

If the patient is able to talk in phrases, spirometry and PEF can be considered. In some circumstances, it may be appropriate to defer spirometry until the patient has improved with treatment.