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Persistent asthma follow-up — USMLE Step 3 MCQ

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HardPediatricsPersistent asthma follow-upUSMLE Step 3

A 9-year-old boy uses low-dose inhaled corticosteroid daily with good technique but still has symptoms 5 days per week, nighttime awakening weekly, and two exacerbations requiring systemic glucocorticoids in the past year. FEV1 is 76% predicted with reversibility, adherence is confirmed, and environmental triggers have been addressed. Which regimen is preferred next?

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Correct answer: C — Use low-dose inhaled corticosteroid-formoterol for maintenance and symptom relief

The best answer is “Use low-dose inhaled corticosteroid-formoterol for maintenance and symptom relief”. He has uncontrolled moderate persistent asthma with recurrent severe exacerbations despite low-dose ICS. NHLBI recommends single maintenance and reliever therapy with ICS-formoterol at Step 3 for children aged 4–11 years, with an age-specific maximum of eight puffs daily and instructions to seek care if more is needed. LABA monotherapy and chronic systemic glucocorticoids expose him to avoidable harm.

Reference: NHLBI 2020 Focused Updates: Asthma Management: https://www.nhlbi.nih.gov/sites/default/files/publications/Asthma%20Clinicians%20Guide%20508_02-03-21.pdf