What should be the first-line treatment for a severe asthma exacerbation?

In the management of a severe asthma exacerbation, the first-line treatment focuses on quickly relieving bronchospasm and improving airflow. Continuous albuterol nebulization is the preferred choice because beta-agonists like albuterol are effective in rapidly dilating the airways. This rapid action can considerably alleviate symptoms during an exacerbation.

In severe cases, continuous administration can provide a more consistent bronchodilatory effect compared to intermittent doses, making it especially beneficial for patients who are experiencing significant respiratory distress. While adjunctive treatments such as systemic corticosteroids may be necessary to address underlying inflammation, the immediate priority during an exacerbation is to ensure adequate airway patency and oxygenation, which albuterol achieves effectively.

The other options, while important in overall asthma management, are not the first-line treatment during an acute exacerbation. Inhaled corticosteroids and montelukast play a broader role in long-term control rather than acute relief, and IV steroids are typically reserved for more critical cases or for patients who are unable to take oral medications. Thus, using continuous albuterol nebulization is the most appropriate initial action in this scenario.