American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a potential first-line treatment during an asthma exacerbation if the FEV1 or PEF is between 40% and 69%?

1. Inhaled corticosteroid adjustment

2. Emergency room visit

3. Ward admission

4. Routine follow-up

The correct answer is: Ward admission

During an asthma exacerbation when the forced expiratory volume in one second (FEV1) or peak expiratory flow (PEF) is between 40% and 69%, the patient's airflow limitation indicates a moderate exacerbation. In this scenario, it is essential to provide a more intensive level of care compared to less severe cases. The appropriate first-line treatment is often to escalate management, which may include facilitating continued observation and intensive treatment, possibly requiring hospitalization. Admission to the ward allows for closer monitoring, frequent administration of bronchodilators (such as short-acting beta-agonists), and evaluation for potential worsening of the patient's condition. While other options, such as inhaled corticosteroid adjustment or routine follow-up, can be relevant in asthma management, they are not sufficient for addressing a moderate exacerbation where more immediate and aggressive treatment is warranted. An emergency room visit may be necessary for initial evaluation, but ongoing management and treatment are crucial, which is best achieved by admitting the patient to a ward setting for careful monitoring and therapy.