The patient presents with severe asthma exacerbation characterized by wheezing, silent chest, and hypoxia (SpO2 85%), indicating life-threatening bronchospasm and airflow obstruction. The immediate priority is to reverse bronchoconstriction and improve oxygenation. Nebulized salbutamol (a short-acting β2-agonist) rapidly dilates bronchial smooth muscle, while ipratropium (an anticholinergic) provides additional bronchodilation by blocking muscarinic receptors. This combination is the first-line emergency treatment to restore airflow quickly. Oral corticosteroids and IV aminophylline have roles but act slower and are not immediate rescue treatments. Antibiotics are not indicated unless there is evidence of infection.

Reference: Harrison’s Principles of Internal Medicine, Fauci et al., 20th Edition.