An adolescent with exercise-induced asthma reports reduced effectiveness of albuterol with regular practice. What is the best next step in management?

An adolescent with exercise-induced asthma reports reduced effectiveness of albuterol with regular practice. What is the best next step in management?

• A. Increase albuterol to 4 puffs
• B. Decrease practices
• C. Order daily inhaled corticosteroid medication
• D. Add cromolyn sodium

Answer: (C)

The key idea is that ongoing exercise-induced asthma with diminishing relief from a rescue inhaler signals that underlying airway inflammation isn’t adequately controlled. The best next step is starting daily inhaled corticosteroids, the main controller therapy for persistent asthma. By reducing airway inflammation and hyperresponsiveness, ICS decreases the frequency and severity of exercise-induced bronchospasm and lowers the need to rely on albuterol during regular practice. This approach addresses the root problem, not just the immediate symptoms. Pre-exercise use of a rescue inhaler can still be appropriate for immediate protection, but it won’t correct the chronic inflammation driving symptoms. Increasing albuterol would treat symptoms temporarily but risks masking poor control and doesn’t address inflammation. Decreasing practice isn’t a productive solution for long-term health and athletic goals. Cromolyn sodium is a less effective preventive option compared with ICS and is not preferred as the first-line step in adolescents with persistent symptoms.

The key idea is that ongoing exercise-induced asthma with diminishing relief from a rescue inhaler signals that underlying airway inflammation isn’t adequately controlled. The best next step is starting daily inhaled corticosteroids, the main controller therapy for persistent asthma. By reducing airway inflammation and hyperresponsiveness, ICS decreases the frequency and severity of exercise-induced bronchospasm and lowers the need to rely on albuterol during regular practice. This approach addresses the root problem, not just the immediate symptoms.

Pre-exercise use of a rescue inhaler can still be appropriate for immediate protection, but it won’t correct the chronic inflammation driving symptoms. Increasing albuterol would treat symptoms temporarily but risks masking poor control and doesn’t address inflammation. Decreasing practice isn’t a productive solution for long-term health and athletic goals. Cromolyn sodium is a less effective preventive option compared with ICS and is not preferred as the first-line step in adolescents with persistent symptoms.