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Problem: HT, a 45 y/o man with severe persistent asthma, presents to the ED with severe dyspnea and wheezing. He can only say 2-3 words without taking a breath. He takes beclomethasone and albuterol PRN. He ran out of his beclomethasone inhaler a week ago; since then, he has been using his albuterol ~ every 3 hours. His FEV1 is 25% of what is predicted, and his O2 saturation is 82%. Vitals are HR 130, RR 30, and BP 130/90. Albuterol and ipratropium were given by nebulizer with little improvement. Oxygen at 4L/min by NC was started, followed in 20 minutes by a second dose of albuterol. Subsequently, the patient's HR increased to 140, and he c/o palpitations and shakiness. What adverse effects is HT experiencing that are consistent with/ beta-agonist administration? Why did HT fail to respond to the initial therapy? Could tolerance to the beta-agonists have contributed?
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