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Childhood asthma — RACGP Fellowship MCQ

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ModeratePaediatrics and adolescentChildhood asthmaRACGP Fellowship

A 9-year-old child presents with wheeze and cough triggered by exercise. Symptoms occur twice weekly and wake him once a month. Spirometry shows reversible airway obstruction. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Start low-dose inhaled corticosteroid-containing preventer therapy and provide a written asthma action plan

Option B is correct. The child has persistent asthma (≥2 symptoms per week, monthly nocturnal awakening) requiring daily preventer therapy. Low-dose ICS is the evidence-based first-line maintenance agent in childhood asthma, reducing airway inflammation and exacerbation risk while allowing normal activity. An asthma action plan is essential for family education and crisis management. Option E is incorrect: daily oral prednisolone is not a preventer and risks significant adverse effects. Option D is incorrect: asthma is not infectious; antibiotics have no role. Option C is incorrect: appropriately treated asthmatic children should be encouraged to exercise; avoidance worsens disability. Option A is incorrect: long-acting beta-agonist monotherapy without ICS increases exacerbation and mortality risk and is contraindicated in monotherapy.

Reference: National Asthma Council Australia (2019). Australian Asthma Handbook, V2.1. Available at https://www1.racgp.org.au/newsgp/clinical/significant-update-on-asthma-management; also consistent with GINA 2024 and Therapeutic Guidelines.