Emergency Treatment of Asthma

Copyright © 2010 Massachusetts Medical Society. A 46-year-old woman who has had two admissions to the intensive care unit (ICU) for asthma during the past year presents with a 4-day history of upper respiratory illness and a 6-hour history of shortness of breath and wheezing. An inhaled corticosteroid has been prescribed, but she takes it only when she has symptoms, which is rarely. She generally uses albuterol twice per day but has increased its use to six to eight times per day for the past 3 days. How should this case be managed in the emergency department?