A child with asthma presents with wheezing and shortness of breath after exposure to a known trigger. What is the priority intervention?

• A. Administer inhaled corticosteroid and reassess.
• B. Administer long-acting beta-agonist.
• C. Administer a quick-relief inhaled bronchodilator (short-acting beta-agonist) and reassess.
• D. Administer oxygen therapy only.

Answer: (C)

In an acute asthma attack, the immediate goal is to rapidly reverse bronchospasm to restore airway patency. A quick-relief inhaled bronchodilator (short-acting beta-agonist like albuterol) acts within minutes to relax the bronchial smooth muscle, open the narrowed airways, and quickly improve wheezing and shortness of breath. This rapid relief is why it’s the priority intervention—the patient’s ventilation improves almost immediately, and you can then reassess to decide if more treatment is needed.

Maintenance therapies, like inhaled corticosteroids, and long-acting beta-agonists, don’t provide rapid relief and are intended for control and prevention, not for acutely reversing an attack. Oxygen therapy is important if the patient’s oxygen saturation is low, but it does not address the bronchoconstriction by itself; the bronchodilator comes first to relieve the immediate airway obstruction, with oxygen added as needed based on monitoring. After the bronchodilator, reassess to determine if additional doses or other therapies are required.