For a 13-year-old boy in respiratory distress with a peak flow of 250 L/min, what management would likely prevent hospitalization?

Inhaled anticholinergic agents, when used in combination with a short-acting beta-agonist (SABA), can provide a synergistic effect that enhances bronchodilation and improves airflow in patients experiencing respiratory distress. In this specific case of a 13-year-old boy with a peak flow of 250 L/min (indicating significant airflow obstruction), utilizing both an inhaled anticholinergic and a SABA can be particularly effective.

The SABA works quickly to relax the smooth muscles of the airways and open them up, while the anticholinergic agent helps to counteract bronchoconstriction through different mechanisms. This dual approach not only helps in immediately alleviating acute symptoms of asthma but also can prevent further deterioration, reducing the likelihood of hospitalization due to severe asthma exacerbation.

Other options, such as oral corticosteroid therapies and increasing the frequency of short-acting beta-agonists, may also be part of asthma management but do not have the same immediate synergistic effects as the combination of inhaled agents. Inhaled corticosteroids are primarily used for long-term control and prevention of asthma symptoms rather than for acute management, and over-reliance on escalating SABA use can lead to poor asthma control. Therefore