In an acute asthma exacerbation with SpO2 of 86%, what is the priority intervention?

• A. Start IV antibiotics.
• B. Begin diuretic therapy.
• C. Administer short acting bronchodilator and oxygen.
• D. Initiate tachypnea observation only.

Answer: (C)

When a patient with an acute asthma flare is hypoxic (SpO2 around 86%), the first priority is to relieve the airway constriction and correct the low oxygen level. Administering a rapid-acting bronchodilator inhaled therapy, such as albuterol, rapidly relaxes airway smooth muscle and opens the airways, improving airflow and ventilation. At the same time, providing supplemental oxygen addresses the hypoxemia directly, helping to restore blood oxygen levels and reduce the work of breathing. Together, these actions tackle the two most immediate problems in an asthma attack: bronchospasm and inadequate oxygenation.

Antibiotics aren’t indicated unless there’s a concurrent infection. Diuretics don’t treat asthma and can cause fluid and electrolyte imbalances that don’t help, and merely observing the patient without treatment misses the critical need to improve airflow and oxygen delivery. In practice, this initial combination is followed by additional therapies (such as steroids or inhaled anticholinergics, and possibly magnesium sulfate in severe cases) as needed, but the priority remains bronchodilation plus oxygenation.