Adolescent asthma — CCFP MCQ

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ModeratePaediatrics and adolescentAdolescent asthmaCCFP

A 13-year-old girl has intermittent wheeze with exercise and wakes coughing twice monthly. Spirometry shows reversible obstruction. She uses salbutamol before sports 4 days per week and has allergic rhinitis. What is the most appropriate next step in management?

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Correct answer: C — Start inhaled corticosteroid maintenance therapy and review inhaler technique

Explanation lettering: C = shown as B · B = shown as C

The correct answer is B. This patient has progressed beyond 'very mild intermittent' asthma (treatable with SABA alone) to mild *persistent* asthma, based on symptom frequency (4 days/week exercise-induced wheeze + 2×/month nighttime cough). Current Canadian Thoracic Society guidelines (2021, 2012) mandate early introduction of low-dose inhaled corticosteroid monotherapy as maintenance therapy for all children with confirmed mild persistent asthma, regardless of symptom frequency. Inhaler technique review is standard and critical to ensure adequate drug delivery. Option A fails because SABA monotherapy increases exacerbation risk and is no longer recommended; sports avoidance is harmful. Option C is inappropriate (prednisone is for acute crises, not maintenance). Options D and E are medically irrelevant. The discriminating feature is recognizing that symptom frequency and nighttime symptoms indicate persistence requiring anti-inflammatory maintenance, not intermittent relief alone.

Reference: Canadian Thoracic Society 2021 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children, and Adolescents (published as CPS Practice Point, PubMed PMID 38586489, April 2024); https://pubmed.ncbi.nlm.nih.gov/38586489/