Answer:USMLE step 2 Mcq 147:Johnny, a 5 year old child, presents with recurrent attacks of wheezes and respiratory difficulty that occurs at random times


Correct Answer: B
Let’s outline what we have to deal with here. First, the patient is a 5 year old child. This presents a big problem when it comes to compliance. Also, certain drugs are contraindicated due to the fact that this child is in a growing phase. Therefore, beclamethasone, which is a Glucacorticoid, should not be the drug of choice. It may stunts the boy's growth. Cromolyn sodium is not appropriate either, because it is mainly used in preventing acute attacks. It is not given to acute asthmatic attacks. Theophylline inhalers and salmetarol inhalers are out too. Children at that age do not know how to use or handle an inhaler.
The best medication for a child in this age is an oral medication. Bronchodilators help to relieve acute symptoms, such as coughing, wheezing or difficulty breathing by relaxing tight breathing tubes in the lung. They are available in different forms, including syrup, tablet, MDI and solution for use with a nebulizer.
Names for commonly used bronchodilators include: Albuterol, Ventolin, and Proventil. Albuterol is the generic name, while Proventil and Ventolin are different brand names, but they are all the same type of medication (beta 2 agonist).
There is a newer form of albuterol now available that has less side effects. It is called levalbuterol (Xopenex) and it may be useful for children who can not tolerate albuterol nebulizer treatments. A recent study has also shown that Xopenex may be more effective for some children, including those in the emergency room, where it decreased hospital admissions by 11% as compared to regular Albuterol.
Another type of bronchodilator, called Atrovent (ipratropium bromide) is sometimes used with albuterol for acute asthma attacks. Unlike albuterol, atrovent is an anticholinergic medicine. This type of medication is also commonly referred to as: <br> quick-relief medication relievers  short acting bronchodilators <br> rescue inhaler or rescue medication  Bronchodilators are generally used on and as needed basis. When the child is having trouble with coughing, wheezing or difficulty breathing you can begin to use them every four to six hours (except for the syrup form which is only used three times a day) . 
If the child only has coughing or wheezing after physical activities, then he may have exercise induced asthma. For this problem, it is best to use a bronchodilator 20-30 minutes before activities that make him wheeze. Also, the child should avoid intense activities done in cold, dry air (swimming is a good sport for children with exercise induced symptoms).  If the child is using a bronchodilator regularly, such as more than once every one to two weeks, a preventative medication can be started.   Commonly used short term bronchodilators include:   Proventil HFA - a CFC free metered dose inhaler   Albuterol (Ventolin, Proventil) - MDI and nebulizer soln   Levalbuterol (Xopenex) - nebulizer soln   Bitolterol (Tornalate) - MDI and nebulizer soln  Pirbuterol (Maxair) - metered dose inhaler   Terbutaline (Breathaire)   Albuterol rotahaler (Ventolin rotocaps) - a dry powder inhaler   Ipratropium (Atrovent) - MDI and nebulizer soln


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