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 3

Which of the following statements about early treatment of severe asthma are true? 
Select as many as you wish.

	a. A face mask should be used rather than a mouth piece for nebuliser  administration of a beta2 agonist.
	b. When using a nebuliser patients should be advised to mouth-breathe.
	c. A beta2 agonist can be given continuously and safely without major adverse effects.
	d. If a nebuliser is unavailable, use a metered dose inhaler in the usual dose of 2 puffs, to give rapid effect.

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Answer 3

d. If a nebuliser is unavailable use a metered dose inhaler in the usual dose of 2 puffs for rapid effect - The authors disagree.

A metered dose inhaler (e.g. Ventolin, Bricanyl) with a large-volume spacer (e.g. Volumatic, Nebuhaler) should be used. It is important to ensure that the patient receives an adequate dose (8 puffs of salbutamol MDI are equivalent to one 5mg nebulised dose of salbutamol).