A 7-year-old with moderate persistent asthma has poor control on low-dose inhaled corticosteroid (ICS) alone. The preferred step-up therapy according to GINA guidelines is:

• A Switch to oral prednisolone long-term
• B Add an antileukotriene (montelukast) as the sole step-up
• C Double the dose of ICS only
• D Add a long-acting beta-2 agonist (LABA) to the existing ICS ✓

Explanation

Per GINA Step 3 guidelines for children 6 years and above with uncontrolled asthma on low-dose ICS, the preferred step-up is to add a LABA (e.g., salmeterol or formoterol) to the ICS as a combination inhaler. This has superior efficacy to increasing ICS dose alone or adding montelukast alone in this age group. Oral steroids are only for severe exacerbations. LABA should never be used without ICS in asthma due to risk of masking worsening inflammation.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.