National Asthma Educator Certification Board (NAECB) Practice Exam

Which patient is considered at the highest risk for experiencing an asthma exacerbation?

1. An 18-month-old on daily nebulization of Pulmicort Respules

2. A 7-year-old who wheezes when exposed to Alternaria

3. A 13-year-old who required one course of oral steroid in the last year

4. A 22-year-old who fills two Albuterol inhalers monthly

The correct answer is: A 22-year-old who fills two Albuterol inhalers monthly

The 22-year-old patient who fills two Albuterol inhalers monthly is considered at the highest risk for experiencing an asthma exacerbation. This frequency of Albuterol use indicates that the patient likely has poorly controlled asthma. Albuterol is a rescue medication used to relieve acute symptoms and is not intended for regular use. When a patient relies on short-acting bronchodilators like Albuterol at such a high frequency, it signals that their asthma management is insufficient, and they may be experiencing frequent episodes of wheezing or breathlessness. Patients who require frequent use of rescue medications tend to have more significant underlying airway inflammation and exacerbation triggers, which can lead to more severe acute asthma attacks. This situation necessitates a reevaluation of their asthma management plan, possibly involving the introduction of a long-term control medication, such as inhaled corticosteroids, to improve overall asthma control and reduce the frequency of rescue medication use.