What is the recommended next step for an adult asthma patient with a PEF less than 40% predicted according to REMAC guidelines?

For an adult asthma patient with a peak expiratory flow (PEF) less than 40% predicted, the recommended next step according to REMAC guidelines is the administration of continuous nebulized albuterol. This approach is taken because the patient is experiencing severe bronchospasm, and continuous nebulization allows for a sustained bronchodilation effect. This method provides a higher and more consistent delivery of the medication to the airways compared to intermittent doses, which can be particularly beneficial in acute situations.

Continuous albuterol is critical in this scenario since it can help alleviate the patient's acute respiratory distress by relaxing the bronchial smooth muscles and improving airflow. This intervention is often part of the immediate management protocol for severe asthma exacerbations, particularly when the patient's condition is critical and rapid improvement is essential.

While options like oral corticosteroids or high-dose ipratropium bromide may also be part of a comprehensive asthma management plan, they typically serve as adjuncts or longer-term strategies rather than immediate interventions for acute severe cases. Subcutaneous epinephrine, while effective for certain types of severe respiratory distress (such as anaphylaxis), is not indicated specifically for asthma exacerbations unless there is an anaphylactic component involved. Therefore, the continuous delivery of albuterol