Acute asthma exacerbation in adults

Case history

A 27-year-old woman with a history of asthma and taking medium-dose ICS-LABA (inhaled corticosteroid-long acting beta agonist) and a leukotriene receptor antagonist presents to the emergency department with progressive worsening of shortness of breath, wheezing, and cough over 3 days. She reports prior exposure to a person who had a runny nose and a hacking cough. She has not received significant relief from her reliever inhaler, with worsening symptoms despite increased use. She has been taking her maintenance asthma medications regularly, and uses albuterol as reliever therapy. Her cough is disrupting her sleep pattern and as a consequence she is experiencing daytime somnolence, which is affecting her job performance.