A 34-year-old woman with a history of moderate persistent as…
A 34-year-old woman with a history of moderate persistent asthma is admitted to the medical floor for an acute asthma exacerbation. She reports 4 days of progressive dyspnea, wheezing, and nocturnal cough despite using her albuterol inhaler every 2 hours at home. She states she ran out of her maintenance inhaler 2 weeks ago and has not refilled it. Vital signs are: BP 128/78, HR 118, RR 28, temperature 37.2°C (99°F), SpO2 91% on room air. Physical examination reveals diffuse expiratory wheezing throughout all lung fields, use of accessory muscles, and difficulty speaking in full sentences. Chest X-ray shows hyperinflation with flattened diaphragms and no infiltrates or pneumothorax. The decision is made to admit the patient to the medical floor for acute asthma exacerbation. In addition to oxygen, what is the most appropriate initial respiratory treatment regimen for this patient?