A 7-year-old child with moderate persistent asthma is on inhaled budesonide 200 mcg/day. Despite this, he continues to have symptoms 4–5 days per week and nighttime wakening twice weekly. Spirometry shows FEV1 72% predicted with significant bronchodilator reversibility. According to GINA 2023 step-up strategy, what is the preferred add-on therapy?
- A Increase inhaled corticosteroid dose to 400 mcg/day budesonide
- B Add a long-acting beta-2 agonist (LABA, e.g., salmeterol or formoterol) to the existing ICS ✓
- C Switch to montelukast (LTRA) monotherapy
- D Add oral theophylline as add-on bronchodilator
Explanation
GINA 2023 and IAP asthma guidelines recommend stepping up from Step 2 (low-dose ICS) to Step 3 by adding a long-acting beta-2 agonist (LABA) to the existing ICS rather than merely doubling the ICS dose. In children ≥5 years, ICS/LABA combination (e.g., budesonide/formoterol or fluticasone/salmeterol) is the preferred step-up option, as it improves symptom control and reduces exacerbations more effectively than ICS doubling. LTRAs (montelukast) are an alternative add-on but have demonstrated inferior efficacy to ICS/LABA. Oral theophylline is no longer recommended as a preferred add-on due to narrow therapeutic index and inferior efficacy.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.