Asthma — CCFP MCQ

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ModerateChronic disease managementAsthmaCCFP

A 45-year-old woman has daytime wheeze twice weekly and wakes with cough twice monthly. She uses salbutamol several times each week and has had one urgent-care visit this year. Spirometry shows reversible airflow obstruction. What is the most appropriate next step in management?

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Correct answer: C — Start an inhaled corticosteroid-containing controller regimen

This patient has inadequately controlled, mild persistent asthma requiring step-up from SABA monotherapy. Canadian Thoracic Society (CTS) 2012 and 2021 guidelines recommend inhaled corticosteroid initiation as first-line maintenance therapy for all asthma beyond very mild intermittent disease, and particularly when SABA use exceeds 2 days per week, nocturnal symptoms occur, or exacerbations have been documented. This patient meets all three criteria. Option E (SABA alone) fails to address inflammation, violates guideline recommendations, and perpetuates risk of worsening control and exacerbations. Option D (oral prednisone) is inappropriate as maintenance therapy and is reserved for severe uncontrolled asthma. Option A (antibiotics) is incorrect because asthma is not an infectious process. Option B (chest CT) is unnecessary when reversible airflow obstruction has already been confirmed on spirometry.

Reference: Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults. PubMed PMID: 22536582. Also: CFP 2023 'Individualized treatment strategies and considerations in patients with mild asthma' https://www.cfp.ca/content/69/12/829