Question

A 10 year old male with asthma returns to his physician for follow up. Two months ago, his teacher noted him wheezing after playing on the playground, and pulmonary function testing confirmed a diagnosis of asthma. Since that time, he has been using a rescue inhaler approximately one time a week at school to relieve wheezing and chest tightness that seem to occur following strenuous activity. He has also been using his rescue inhaler approximately one time a week at home at night when he awakens with chest tightness or difficulty breathing. Current medications include albuterol and atomoxetine. On physical exam, the patient is comfortable and afebrile. The patient's lungs are clear to auscultation, and no wheezing or prolonged expiration is noted. Which of the following is the most appropriate next step in the management of this patient?

A. Repeat spirometry
B. Cetirizine
C. Inhaled salmeterol
D. Inhaled fluticasone
E. Oral prednisone

Answer 1

The most appropriate next step in the management of the 10-year-old patient's asthma is Option D, inhaled fluticasone. This medication will help to control asthma symptoms by reducing inflammation in the airways and is indicated for patients who are using rescue inhalers frequently, suggesting uncontrolled asthma.

Step-by-step explanation:

The most appropriate next step in the management of this 10-year-old male with asthma is the initiation of a long-term control medication. Given that the patient is using his rescue inhaler at least twice a week, it suggests that his asthma is not well-controlled with the current regimen. In such cases, long-term maintenance therapy, such as inhaled corticosteroids, is recommended to reduce airway inflammation and prevent future asthma attacks.

The most appropriate choice from the options provided is inhaled fluticasone (Option D). Fluticasone is an inhaled corticosteroid that provides long-term control of asthma symptoms by reducing inflammation in the airways, preventing the frequency and severity of asthma attacks.

Options A (Repeat spirometry) and C (Inhaled salmeterol) are not indicated at this time, as the goal is to provide long-term control and not just monitor lung function or provide short-term relief. Option B (Cetirizine) could help if the asthma was allergy-triggered, and an antihistamine might be considered, but the patient's symptoms do not appear to be directly related to allergies. Option E (Oral prednisone) is typically reserved for exacerbations of asthma not controlled by inhaled steroids and not as a first step in managing uncontrolled asthma symptoms.