A 4-year-old child with moderate persistent asthma (daily symptoms, nighttime awakening 3–4 times/week, FEV1 65% predicted) is on low-dose inhaled corticosteroid (ICS) + short-acting β2-agonist (SABA) as needed. What is the recommended step-up in therapy according to GINA 2024 guidelines for this age group?
- A Add oral montelukast as add-on therapy
- B Add long-acting β2-agonist (LABA) to low-dose ICS (combination therapy) ✓
- C Step up to medium-dose ICS alone
- D Switch to high-dose ICS plus oral theophylline
Correct answer: B. Add long-acting β2-agonist (LABA) to low-dose ICS (combination therapy)
Explanation
GINA 2024 Step 3 treatment for children 6–11 years with uncontrolled asthma on low-dose ICS is medium-dose ICS, OR low-dose ICS + LABA, OR low-dose ICS + LTRA. For children in the 5–11 age group with moderate persistent asthma, the preferred step-up is low-dose ICS plus LABA (combination inhaler). This is supported by RCT evidence showing superior lung function improvement and reduced exacerbations. Montelukast is a less preferred step-up option. GINA emphasizes avoiding SABA-only treatment and moving toward ICS-formoterol as reliever therapy in older children.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.