A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma?
A. Corticosteroids promote bronchodilation.
B. Corticosteroids act as an expectorant.
C. Corticosteroids have an anti-inflammatory effect.
D. Corticosteroids prevent development of respiratory infections.
Correct Answer: C. Corticosteroids have an anti-inflammatory effect.
Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. At a physiologic level, steroids reduce airway inflammation and mucus production and potentiate beta-agonist activity in smooth muscles and reduce beta-agonists tachyphylaxis in patients with severe asthma. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.
Option A: Short-acting inhaled beta-agonists are the drug of the first choice in acute asthma. Albuterol is preferred over metaproterenol in that class because of its higher beta 2 selectivities and longer duration of action. The dose-response curve and duration of action of these medications are adversely affected by a combination of patient factors, including pre existing bronchoconstriction, airway inflammation, mucus plugging, poor patient effort, and coordination.
Option B: Anticholinergics have a variable response in acute exacerbation with a somewhat underwhelming bronchodilatory role. However, they can be useful in patients with bronchospasm induced by beta-blockade or severe underlying obstructive disease with FEV1 less than 25% of predicted.
Option D: Graham et al. conducted a randomized double-blinded trial and demonstrated no difference in improvement in symptom score, spirometry, or length of hospitalization with routine use of antibiotics in status asthmaticus. That does not mean that patients with clinical signs of infection should not be treated with antimicrobials, or due diligence should not be pursued in obtaining respiratory culture specimens early on.
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