What's the Best Next Step?

Clinical Focus:

• A 45-year-old female presents with acute severe asthma refractory (unresponsive) to initial dual bronchodilator therapy consisting of nebulised short-acting beta-2 agonist (Salbutamol) and short-acting muscarinic antagonist (Ipratropium bromide).

Diagnostic criteria for severe asthma include:

• Peak Expiratory Flow (PEF) between 33% and 50% of predicted normal
• Tachypnoea (respiratory rate ≥ 25 breaths per minute)
• Tachycardia (heart rate ≥ 110 beats per minute)
• Inability to complete full sentences in a single breath due to severe breathlessness

When initial back-to-back inhaled bronchodilator therapy fails to yield immediate symptomatic or physiological improvement, prompt escalation to systemic corticosteroids is the primary evidence-based standard of care.

Here is the Management Strategy: