A 30-year-old man with asthma remains symptomatic despite regular low-dose ICS-formoterol used twice daily plus reliever use. According to the GINA stepwise approach, what is the next preferred step?

• A Add a long-acting oral beta agonist
• B Switch reliever to short-acting ipratropium
• C Step up to medium-dose ICS-formoterol maintenance and reliever therapy ✓
• D Start daily low-dose oral prednisolone

Explanation

GINA Step 4 is medium-dose ICS-formoterol as maintenance and reliever therapy (MART). Formoterol's rapid onset allows it to serve both roles, improving control and reducing exacerbations versus fixed dosing with SABA reliever. Long-acting oral beta agonists are obsolete due to cardiac toxicity, chronic oral steroids carry unacceptable systemic harm, and ipratropium has no role as a routine asthma reliever.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.