Clinical Pearl of the Month – A 27 Year-Old Woman with Asthma Exacerbation

Gerard Kiernan, MD, FAAFP, FHMClinical Pearls, Family Medicine, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Pediatric Medicine, Physician Assistant

asthma exacerbation case

Asthma exacerbation in a 27-year-old woman.

Guidelines and Treatment for Asthma Pearls of Wisdom Q&A Case

Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families and the community. It causes respiratory symptoms, limitation of activity, and flare-ups (attacks) that sometimes require urgent health care and may be fatal. Asthma attacks - called asthma exacerbations - can be classified as mild, moderate, severe, or life threatening. Let's look at the pearls in treating asthma exacerbations and asthma therapy.

Patient Case:

A 27-year-old woman was seen in an urgent care and treated with nebulized albuterol and ipratropium for an asthma exacerbation. She was directed to follow up in primary care to make a plan for ongoing asthma therapy.  

She smokes only when going out to bars with friends and doesn’t live with any smokers. She has no dogs or cats.

She denies chronic cough and she is rarely awakened by wheezing, cough, and dyspnea.

She has episodes of wheezing and shortness of breath once or twice a week. 

She had been using an old prescription for an albuterol metered dose inhaler until that ran out.

She has had the episodes of wheezing, off and on, especially when suffering from a cold, since childhood.

On examination, she has normal vital signs and clear lungs. Spirometry results are normal, with no decrease from predicted FEV1 value.


According to the most recent expert asthma guidelines, what medication should she use when she has an asthma exacerbation?

Answer Options:

Albuterol Metered Dose Inhaler as needed

Budesonide+Formeterol combination inhaler as needed

Montelukast 10mg tablet daily

Salmeterol inhaled twice daily

See the Answer:

About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.

About Clinical Pearl of the Month:

Med-Challenger's Clinical Pearl Blog Series is a recurring segment of Med-Challenger's popular Medical Education BlogSubscribe for more free pearls of wisdom. Opt-out anytime.

About Med-Challenger:

Med-Challenger provides online medical education products and services to physicians, nurses, and other medical specialists as well as medical training programs and healthcare groups world-wide via its web-based medical education library and world-class assessment platform at

Asthma exacerbation patient case

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