In acute asthma, if the initial response to a short-acting beta-agonist is incomplete, which of the following may be added?

• A. Systemic corticosteroids
• B. Inhaled corticosteroids
• C. Theophylline
• D. Ipratropium bromide added to SABA

Answer: (D)

When a child with acute asthma does not respond fully to a short-acting beta-agonist, adding another bronchodilator with a different mechanism can improve relief quickly. Ipratropium bromide is an inhaled anticholinergic that blocks muscarinic receptors in the airways, which reduces reflex bronchoconstriction and mucus production. This makes its bronchodilating effect additive to the SABA, often producing better improvement in symptoms and lung function than using the SABA alone, especially in moderate to severe attacks.

The other options don’t provide the same rapid, complementary bronchodilation in this immediate setting. Systemic corticosteroids help control inflammation but don’t act fast enough to rescue acutely within minutes; inhaled corticosteroids are for long-term control and have little role in an acute rescue) response; theophylline is an older, less favorable option due to a narrow therapeutic window and slower onset.