A 26-year-old woman with asthma experiences a six-hour episode of shortness of breath after exposure to smoke. After three nebulized albuterol treatments, oxygen saturation improves to 96% on room air. What is the most appropriate disposition?

• A. Admit to inpatient observation
• B. Intubate for airway protection
• C. Discharge with prescriptions for an albuterol inhaler and prednisone
• D. Initiate long-term inhaled corticosteroid therapy only

Answer: (C)

In an acute asthma flare, the goal is to rapidly relieve bronchospasm and ensure adequate oxygenation. This patient had six hours of symptoms from smoke exposure and improved to 96% saturation on room air after three nebulized albuterol treatments, with no signs of impending respiratory failure described. That level of stabilization supports discharge rather than admission or airway intervention.

A short course of systemic corticosteroids is indicated in moderate-to-severe exacerbations to quell airway inflammation and reduce the risk of relapse, so giving prednisone is appropriate even after improvement. At discharge, a rescue inhaler is essential so the patient can manage any future symptoms at home, and providing instructions for use plus an asthma action plan helps prevent relapse.

Long-term inhaled corticosteroids are important for chronic control but do not address an acute flare by themselves, and this patient’s immediate needs are best met with a rescue inhaler plus a short steroid burst, not solely chronic maintenance therapy.