A 7-year-old child is taken to the emergency depament because he is feeling sho of breath. The episode began about an hour previously while the child was playing spos, when he abruptly developed paroxysms of wheezing and coughing. As the physician enters the room, he notes that the child is sitting leaning forward and is using his accessory respiratory muscles. Physical examination demonstrates tachypnea and tachycardia. On auscultation, a prolonged expiratory phase with relatively high-pitched wheezes through much of the respiratory cycle are heard. No fine crackles are heard. Which of the following medications will have the fastest onset if the 7-year-old child has an acute attack of his condition?

Albuterol is indicated for use in the treatment of acute signs and symptoms of asthma since its onset is in less than 5 minutes. Beclomethasone is a glucocoicoid agent, and not a sympathomimetic. It would not have the rapid onset of action required in this case. You should immediately recognize that any medication administered orally must be absorbed from the intestinal tract and then reach the site of action. Therefore, you should be able to conclude that oral ephedrine will not begin to work for at least 1/2 hour after administration. Salmeterol inhalation has an onset of action of around 20 minutes and has a duration of action of approximately 12 hours. Salmeterol is indicated for the "chronic" treatment/prevention of asthma signs and symptoms.