For asthma or COPD, which medication is considered if indicated before escalation with other therapies?

• A. Oxygen only
• B. Epinephrine 1:1000
• C. Nitroglycerin
• D. Albuterol, ipratropium, or levalbuterol

Answer: (D)

Relieving bronchospasm quickly is the priority in asthma or COPD exacerbations. Inhaled bronchodilators work fast to relax airway smooth muscle, opening the bronchi and improving airflow. Short-acting beta-2 agonists like albuterol are the primary option, and ipratropium adds further dilation by blocking muscarinic receptors. Levalbuterol serves as another effective inhaled bronchodilator. Using these drugs when indicated helps improve breathing before moving on to other therapies such as systemic steroids or magnesium sulfate. Oxygen is important if the patient is hypoxic, but it’s a supportive measure rather than a bronchodilator. Epinephrine or nitroglycerin aren’t routine first-line therapies for a typical asthma/COPD flare in this setting.