A child who has been diagnosed with asthma for several years has been using a short-acting B2-agonist (SABA) to control symptoms. The child recently began using the SABA two or three times each week to treat wheezing and shortness of breath. The child currently has clear breath sounds and an FEV1 of 75% of personal best. What will the nurse practitioner do next?

A child who has been diagnosed with asthma for several years has been using a short-acting B2-agonist (SABA) to control symptoms. The child recently began using the SABA two or three times each week to treat wheezing and shortness of breath. The child currently has clear breath sounds and an FEV1 of 75% of personal best. What will the nurse practitioner do next?

• A. Add a daily inhaled corticosteroid.
• B. Administer 3 SABA treatments.
• C. Continue the current treatment.
• D. Order an oral corticosteroid.

Answer: (A)

When symptoms are no longer well controlled by rescue medicine alone and lung function drops, the next step is to add a daily anti-inflammatory controller. The child is using a short-acting beta-agonist several times a week and has an FEV1 at 75% of personal best, which indicates persistent, not well-controlled asthma. Rescue inhalers treat acute symptoms but do not address the underlying airway inflammation; introducing daily inhaled corticosteroids helps reduce inflammation, decrease symptom frequency, and prevent exacerbations, which is the appropriate step for mild persistent asthma in kids. The other options don’t fit because relying on more rescue dosing without addressing inflammation doesn’t improve long-term control, continuing the current plan ignores the clear signs of inadequate control, and giving an oral corticosteroid is typically reserved for acute severe flares or poor response rather than as the first step in a child with stable symptoms.

When symptoms are no longer well controlled by rescue medicine alone and lung function drops, the next step is to add a daily anti-inflammatory controller. The child is using a short-acting beta-agonist several times a week and has an FEV1 at 75% of personal best, which indicates persistent, not well-controlled asthma. Rescue inhalers treat acute symptoms but do not address the underlying airway inflammation; introducing daily inhaled corticosteroids helps reduce inflammation, decrease symptom frequency, and prevent exacerbations, which is the appropriate step for mild persistent asthma in kids. The other options don’t fit because relying on more rescue dosing without addressing inflammation doesn’t improve long-term control, continuing the current plan ignores the clear signs of inadequate control, and giving an oral corticosteroid is typically reserved for acute severe flares or poor response rather than as the first step in a child with stable symptoms.