In an acute asthma exacerbation, which description best characterizes the early phase?

• A. Mucosal inflammation and increased mucus production lasting 4-6 hours, with response to oral steroids.
• B. Bronchospasm and mucosal edema occur within minutes and last 1-2 hours, and respond to bronchodilators.
• C. Quiet breath sounds are present.
• D. Fatigue with diminished effort.

Answer: (B)

The early phase of an acute asthma attack is driven by rapid bronchial smooth muscle constriction and swelling of the airway lining after exposure to a trigger. Mediators released from mast cells cause bronchospasm and mucosal edema within minutes, with increased mucus production. This immediate constriction and swelling typically last about 1–2 hours and are most responsive to bronchodilators that relax smooth muscle. Steroids and other anti-inflammatory drugs take longer to work and address the later inflammatory wave, not the initial bronchoconstriction. So describing bronchospasm and mucosal edema starting within minutes, lasting 1–2 hours, and improving with bronchodilators best fits the early phase. Quiet breath sounds or fatigue imply more severe disease or progression beyond this initial phase.