What is a common adjunct therapy for refractory bronchospasm in pediatric asthma beyond albuterol?

What is a common adjunct therapy for refractory bronchospasm in pediatric asthma beyond albuterol?

• A. Theophylline
• B. Oral prednisone only
• C. Ipratropium bromide (as an adjunct to inhaled beta-agonist)
• D. Inhaled corticosteroids as monotherapy

Answer: (C)

When a child with asthma still has significant bronchospasm after use of a short-acting beta-agonist, adding an anticholinergic bronchodilator is a common and effective step. Ipratropium bromide in inhaled form blocks muscarinic receptors in the airways, which reduces parasympathetic-triggered bronchoconstriction and mucus production. This complements the beta-agonist’s ability to relax airway smooth muscle, providing additional bronchodilation and often improving breathing more than the beta-agonist alone. This approach is especially helpful in moderate to severe exacerbations and is typically given together with the inhaled beta-agonist in the acute setting. Other options don’t fit as well for urgent relief. Theophylline has limited use today due to narrow therapeutic range and systemic side effects. Oral prednisone or systemic corticosteroids help with inflammation but don’t provide immediate bronchodilation in the acute crisis. Inhaled corticosteroids are controller therapy and aren’t used as rescue treatment for an ongoing refractory bronchospasm.

When a child with asthma still has significant bronchospasm after use of a short-acting beta-agonist, adding an anticholinergic bronchodilator is a common and effective step. Ipratropium bromide in inhaled form blocks muscarinic receptors in the airways, which reduces parasympathetic-triggered bronchoconstriction and mucus production. This complements the beta-agonist’s ability to relax airway smooth muscle, providing additional bronchodilation and often improving breathing more than the beta-agonist alone. This approach is especially helpful in moderate to severe exacerbations and is typically given together with the inhaled beta-agonist in the acute setting.

Other options don’t fit as well for urgent relief. Theophylline has limited use today due to narrow therapeutic range and systemic side effects. Oral prednisone or systemic corticosteroids help with inflammation but don’t provide immediate bronchodilation in the acute crisis. Inhaled corticosteroids are controller therapy and aren’t used as rescue treatment for an ongoing refractory bronchospasm.