A 5-year-old child with poorly controlled moderate persistent asthma is already on medium-dose inhaled corticosteroid (ICS). The next add-on medication according to GINA 2023 step-up strategy in children 6 years and above (applicable as age approximation) is:

• A Oral prednisolone 1 mg/kg/day for 5 days
• B Long-acting beta-2 agonist (LABA) added to ICS ✓
• C Leukotriene receptor antagonist (LTRA) monotherapy replacing ICS
• D Increase ICS to high dose and add oral theophylline

Explanation

GINA step 3 treatment for children ≥6 years with inadequately controlled asthma on medium-dose ICS involves adding a long-acting beta-2 agonist (formoterol or salmeterol) to ICS as the preferred step-up. In children <5 years, LABA is not recommended and LTRA or increasing ICS dose are used. LTRA replacing ICS would represent step-down, not step-up. Oral theophylline has a narrow therapeutic index and significant adverse effects, making it a last-resort add-on.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.