He has been taking cough syrup but this has not improved his symptoms. He also had run out of his usual asthma medication salbutamol (2 puffs per night) for three days. It was late November and There was a huge thunderstorm two days ago.

Geronimo presented to hospital with an exacerbation of asthma. On presentation, he was speaking in phrases, his heart rate was 130 beats/minute, respiratory rate (RR) was 25 breaths per minute. His SpO₂ was 94% on room air and he had an audible wheeze. His FEV₁ was 1.64 L (55% of predicted).

Geronimo was administered salbutamol 100 µg 10 puffs via a pressurised metered dose inhaler and spacer and oral prednisolone 0.5mg/kg.

He responded relatively quickly to the treatment; his RR decreased to 21 breaths/minute and he could talk in paragraphs. He remained tachycardic but his FEV₁ improved to 2.2 L (74% of predicted value), demonstrating a significant bronchodilator response of 34%.

His mother who was also present provided a history of Geronimo’s asthma. Both Geronimo and his mother initially reported that Geronimo was well until he caught a cold. However, when probing specifically about his asthma symptoms and overall control Geronimo acknowledged that he had difficultly playing sport especially during his soccer games on Saturdays; he wheezed and coughed when laughing, he avoided running around with his mates to prevent symptoms.

His mother reported that while he might have missed about 10 days of school in the last 12 months, due to a bad cough when he had colds, he was otherwise well apart from the normal cough he gets.

1. Describe the probable reasons for Geronimo’s acute exacerbation of asthma.
2. Based on the history provided by Geronimo and his mother, determine which classification of asthma Geronimo’s asthma fits.
3. Explain the results of his spirometry test. An arterial blood gas (ABG) testing is recommend by a junior doctor for Geronimo, do you agree with this suggestion?
4. Describe the different forms of asthma medication and when each should be used.