What treatment should a 21-year-old male with asthma (chronic respiratory condition) and symptoms of severe cough, runny nose, and body weakness seek?

Treatment for Acute Asthma Exacerbation with Upper Respiratory Symptoms

You need immediate treatment with a short-acting beta-agonist (albuterol/salbutamol) combined with oral corticosteroids (prednisolone 30-60 mg daily), as your severe cough and body weakness indicate an acute asthma exacerbation triggered by an upper respiratory infection. 1

Immediate Treatment (First 24-48 Hours)

Bronchodilator Therapy

• Take nebulized albuterol 5 mg (or 2 puffs via metered-dose inhaler with spacer, repeated 10-20 times if no nebulizer available) immediately 1
• Reassess your response 15-30 minutes after treatment 1
• Continue albuterol every 4-6 hours as needed for symptom control 1

Oral Corticosteroids

• Start prednisolone 30-60 mg daily immediately - this is critical because clinical benefits take 6-12 hours to manifest, and approximately 50% of acute severe asthma episodes are triggered by upper respiratory infections like yours 1, 2
• Continue for 5-10 days without tapering for short courses 1, 3

Upper Airway Symptom Management

• Begin a first-generation antihistamine-decongestant combination for your runny nose, as upper airway cough syndrome (UACS) commonly coexists with asthma and both must be treated for cough resolution 1
• Expect improvement in nasal symptoms within 1-2 weeks, though complete cough resolution may take several weeks 1

Assessment of Severity

Warning Signs Requiring Emergency Care

You should seek immediate emergency department evaluation if you experience: 1

• Inability to complete sentences in one breath
• Pulse >110 beats/min or respirations >25 breaths/min
• Worsening despite initial treatment

Home Monitoring

• Monitor your response to treatment within the first 30 minutes 1
• If symptoms persist or worsen after initial bronchodilator treatment, seek immediate medical attention 1

Transition to Maintenance Therapy (After 48 Hours)

Inhaled Corticosteroids

• Start or optimize inhaled corticosteroids (ICS) immediately - this is first-line maintenance therapy for asthma-related cough 4, 3
• Use beclomethasone 200-800 μg daily equivalent (or equivalent dose of other ICS) with proper inhaler technique using a spacer 4, 3
• Continue ICS twice daily even after symptoms improve, as complete cough resolution may require 4-8 weeks 1, 4

If Cough Persists After Initial Treatment

The American College of Chest Physicians recommends this stepwise escalation: 3

1. First step: Increase ICS dose up to 2000 μg beclomethasone daily equivalent 4, 3
2. Second step: Add montelukast (leukotriene receptor antagonist) to your ICS regimen, as this combination has specific evidence for asthmatic cough 4, 3
3. Third step: Consider another short course of oral corticosteroids only if the above steps fail 4, 3

Critical Pitfalls to Avoid

Common Mistakes

• Do not use newer non-sedating antihistamines (like cetirizine or loratadine) for asthma cough - they are completely ineffective 3
• Do not stop oral corticosteroids prematurely - the full 5-10 day course is necessary even if you feel better 1, 3
• Do not use beta-agonists alone without corticosteroids for more than a few days, as this addresses only bronchospasm but not the underlying inflammation 3

Ensure Proper Technique

• Use a large-volume spacer with your metered-dose inhaler to optimize drug delivery 1, 4
• Take each puff sequentially, not all at once 1

Follow-Up Requirements

• Schedule follow-up within 24-48 hours to assess treatment response 1
• Continue monitoring symptoms and consider keeping a symptom diary 1
• Develop a written asthma action plan for future exacerbations 1

Why Both Conditions Must Be Treated

Your cough will not resolve until both your asthma exacerbation AND upper respiratory symptoms are effectively treated - chronic cough is frequently multifactorial, with UACS and asthma being the two most common causes that often coexist 1. The runny nose indicates UACS, while the severe cough worsened by asthma indicates bronchial hyperreactivity, requiring simultaneous treatment of both conditions.