What is the initial treatment for an asthma exacerbation in the ED?

The initial treatment for an asthma exacerbation in the emergency department focuses on rapid relief of airway obstruction and improving airflow. Inhalation of a bronchodilator, particularly a short-acting beta-2 agonist (such as albuterol), is the cornerstone of immediate management. These medications work quickly to relax the smooth muscles of the airways, leading to bronchodilation, which helps alleviate wheezing, shortness of breath, and chest tightness that are common during an asthma attack.

While corticosteroids are important for reducing inflammation and preventing recurrence after the initial treatment, they do not provide immediate relief of symptoms and are therefore administered later in the treatment protocol. Similarly, oxygen therapy may be necessary if the patient presents with hypoxemia, but it does not directly address the acute bronchospasm. Intravenous fluids may be indicated in certain scenarios, such as severe dehydration or if the patient is unable to take medications orally, but they do not treat the underlying airway obstruction.

Thus, inhalation of a bronchodilator is the correct initial approach in managing an asthma exacerbation due to its rapid action in alleviating acute symptoms and restoring normal breathing.