EXPLANATION
The goal of asthma management is to prevent symptoms, minimize the adverse effects of acute exacerbations and to achieve as normal a lifestyle as possible. If a rapid-acting beta-2-agonist is required more than two days per week, a step up in pharmacotherapy is indicated. Of the choices given, the next step would be the addition of a low dose inhaled corticosteroid.
Continuing only a rapid-acting beta-2-agonist would be inadequate if it is being used more than two days per week.
Oral prednisone would ordinarily not be added unless high-dose inhaled corticosteroids plus a long acting beta-agonist or leukotriene receptor antagonist have not achieved adequate control, and then only for as brief a duration as possible, or for short-term therapy of certain acute exacerbations.
A long acting beta-agonist would ordinarily be added only after unsatisfactory response to low dose inhaled corticosteroids alone and would be discontinued after asthma control is achieved.
A leukotriene receptor antagonist would ordinarily be added only after unsatisfactory response to low dose inhaled corticosteroids alone.
REFERENCES
- Peters SP, Bleecker ER, Canonicals GW et al.: Serious asthma events with budesonide plus formoterol vs. budesonide alone. N Engl J Med. 375:850-860 (2016).
- Stempel DA, Szefler SJ, Pedersen S et al.: Safety of adding salmeterol to fluticasone propionate in children with asthma. N Engl J Med. 375:840-849 (2016).
- Rachelefsky G: Inhaled corticosteroids and asthma control in children: assessing impairment and risk. Pediatrics. 123:353-366 (2009).
