When is bronchodilator therapy indicated in an acute asthma exacerbation, and what clinical responses indicate improvement?

• A. Indicated for bronchospasm with wheeze and increased work of breathing; look for improved breath sounds, reduced work of breathing, improved SpO2, decreased respiratory rate.
• B. Indicated for all pneumonia.
• C. Not indicated in acute asthma; only steroids.
• D. Only in COPD.

Answer: (A)

Bronchodilator therapy is used in acute asthma when there is active bronchospasm with wheeze and increased work of breathing. The goal is to rapidly relax the bronchial smooth muscle, widen the airways, and restore airflow. Signs that the bronchodilator is helping include clearer or improved breath sounds as air entry improves, reduced use of accessory muscles, a lower respiratory rate, and better oxygen saturation. Peak expiratory flow or FEV1 may rise as expiratory airflow improves, confirming a positive response. While steroids are also important in management, bronchodilators provide the immediate relief needed during an acute flare. Bronchodilators aren’t routinely indicated for all pneumonia, aren’t limited to COPD, and their primary role in an acute asthma attack is to reverse bronchoconstriction and improve ventilation.