MRCP2-4317

MRCP2-4317

A 25-year-old patient is brought to the Emergency Department by their partner. They have been experiencing a persistent cough for the past week and have been using their blue inhaler more frequently. Normally, they are prescribed a fluticasone/salmeterol combination inhaler, 250 μg/50 mg BD, and montelukast, 10 mg daily. Their partner is unsure if they have registered with a healthcare provider and is concerned that they may not have filled their prescription.

Upon admission to the Emergency Department, the patient’s respiratory rate is 30 breaths per minute, their PEFR is 240 l/min (predicted 590 l/min), and their O2 saturation is 90%. Oxygen therapy is initiated, and the patient is given a bolus of IV hydrocortisone and a nebuliser containing salbutamol 5 mg and ipratropium 500 μg. The salbutamol nebuliser is repeated three times by the nursing staff.

Later in the evening, the patient’s clinical features on oxygen reveal a respiratory rate of 15 breaths per minute, a PEFR of 230 l/min, a pH of 7.35 (normal range 7.35-7.45), a pO2 of 7.7 kPa (normal range 10.5-13.5 kPa), and a pCO2 of 5.8 kPa (normal range 4.6-6.0 kPa).

What is the most appropriate next step for this patient?