A 4-year-old child with moderate persistent asthma has been on low-dose inhaled corticosteroid (ICS) for 3 months but continues to have nighttime symptoms twice weekly and activity limitation. According to GINA 2024 pediatric stepwise therapy, what is the preferred step-up?
- A Add long-acting beta-2 agonist (LABA) to low-dose ICS
- B Step up to medium-dose ICS monotherapy ✓
- C Switch to oral prednisolone as daily controller
- D Add montelukast to low-dose ICS
Explanation
In children under 5 years (and aged 5–11 years per GINA), if asthma is uncontrolled on low-dose ICS (GINA Step 2), the preferred step-up is to medium-dose ICS (GINA Step 3) rather than adding LABA. LABA (salmeterol, formoterol) is not approved as add-on therapy in children under 5 years; in this age group, medium-dose ICS is the step-3 option. In children ≥5 years, the preferred step-3 option is medium-dose ICS or low-dose ICS + LABA (in those ≥5 years). Oral prednisolone is reserved for step 5 or acute exacerbations. Montelukast (LTRA) can be added as an adjunct but is not the preferred step-up in this age group.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.