American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the management strategy for asthma exacerbation if FEV1 is less than 40%?

1. Home care

2. ICU admission

3. Ward admission

4. Increase SABA frequency

The correct answer is: ICU admission

In cases where the FEV1 (forced expiratory volume in one second) is less than 40%, the severity of the asthma exacerbation indicates a significant impairment of lung function. This level of airway obstruction often correlates with severe symptoms, such as extreme shortness of breath, inability to speak in full sentences, or cyanosis, which may necessitate immediate and intensive medical intervention. The appropriate management strategy in this scenario is ICU admission, as patients with such severe limitations may require close monitoring, advanced therapeutic interventions, and possible mechanical ventilation support. Admission to an ICU setting allows for the rapid administration of systemic corticosteroids and aggressive bronchodilator therapy, while also ensuring access to respiratory support if needed. This level of care is crucial for addressing potential complications associated with severe asthma exacerbations, including respiratory failure. In contrast, less severe options, such as home care, ward admission, or merely increasing the frequency of short-acting beta-agonists (SABA), are insufficient for a patient in this condition. These strategies do not provide the necessary level of monitoring and support needed to manage a patient whose lung function is critically compromised.