A 24-year-old female with persistent asthma uses low-dose inhaled budesonide daily but reports daytime symptoms four days a week and nighttime awakenings. What is the preferred next step in therapy?

Answer and explanation

Correct answer: A. Add a long-acting beta2 agonist

  1. Step 1: Uncontrolled asthma symptoms on low-dose inhaled corticosteroid monotherapy require step-up maintenance therapy under GINA guidelines.
  2. Step 2: The preferred step-up regimen is combining an inhaled corticosteroid with a long-acting beta2 agonist, which achieves superior symptom control and prevents exacerbations.
Answer
Add a long-acting beta2 agonist.
Why not the others: Theophylline is an alternative agent with a narrow therapeutic index and significant toxicity risks, making it non-preferred. Daily oral systemic corticosteroids are reserved for severe refractory step 5 asthma due to significant long-term systemic side effects. Discontinuing inhaled steroids leads to worsening bronchial inflammation.

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