A 30-year-old man with intermittent asthma uses salbutamol inhaler 4 to 5 times a week for symptom relief. He has had no exacerbations requiring oral steroids. According to current GINA recommendations, what is the appropriate next step?

• A Continue salbutamol alone and review in 6 months
• B Add a regular low-dose inhaled corticosteroid ✓
• C Start a long-acting antimuscarinic inhaler
• D Start daily oral prednisolone

Explanation

Reliever use more than twice weekly signals uncontrolled asthma, and GINA recommends adding regular low-dose inhaled corticosteroid (Step 2) because ICS reduce exacerbations and prevent airway remodelling. Continuing SABA alone risks death from severe exacerbation, since SABA monotherapy masks worsening inflammation. LAMA is not a Step 2 option in asthma, and daily oral steroids are reserved for severe refractory disease. The newer GINA approach of ICS-formoterol as reliever also rests on adding ICS.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.