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Asthma stepwise management — GPhC CRA MCQ

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ModerateRespiratory TherapeuticsAsthma stepwise managementGPhC CRA

A 30-year-old woman with asthma controlled on a low-dose inhaled corticosteroid (ICS) presents to the pharmacy. She reports using her salbutamol reliever inhaler 4 times per week and waking at night with wheeze once a week. According to the BTS/SIGN stepwise approach, what is the most appropriate next step?

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Correct answer: B — Add a long-acting beta-2 agonist (LABA) to the low-dose ICS

This patient's asthma is not well controlled on low-dose ICS alone, as evidenced by reliever use >2 times/week and nocturnal symptoms. BTS/SIGN guidelines recommend the addition of a LABA as the preferred step 3 intervention. If the LABA provides a good response, the combination should be continued. A leukotriene receptor antagonist is an alternative if the patient cannot tolerate a LABA. Jumping to high-dose ICS or theophylline is not appropriate at this stage.

Reference: BTS/SIGN 158 Asthma; NICE NG80