In a well-child asthma visit, a child on a daily medium-dose inhaled corticosteroid (ICS) shows poor control with a SABA that provides temporary relief. What is the best next step?

In a well-child asthma visit, a child on a daily medium-dose inhaled corticosteroid (ICS) shows poor control with a SABA that provides temporary relief. What is the best next step?

• A. Have the parent administer all of the child’s medications.
• B. Increase the ICS medication to a high-dose preparation.
• C. Reinforce teaching about the importance of using the SABA.
• D. Teach the child and parent how to use home PEF monitoring.

Answer: (D)

Objective monitoring of asthma control with home peak expiratory flow (PEF) measurements provides real-time data on airway variability and how the child is responding to treatment. When a child on daily inhaled corticosteroids still has poor control despite using a short-acting beta-agonist, the best next step is to obtain objective information before changing therapy. Teaching the child and parent how to perform and track home PEF helps quantify control, reveal day-to-day variability, assess adherence and inhaler technique, and uncover patterns related to triggers or symptoms. This data guides whether to adjust anti-inflammatory therapy, address adherence or technique, or modify environmental factors. Without objective data, simply increasing ICS or overemphasizing rescue inhaler use may be inappropriate or ineffective. Home PEF monitoring sets up a plan to monitor response to any future change and tailor therapy accordingly.

Objective monitoring of asthma control with home peak expiratory flow (PEF) measurements provides real-time data on airway variability and how the child is responding to treatment. When a child on daily inhaled corticosteroids still has poor control despite using a short-acting beta-agonist, the best next step is to obtain objective information before changing therapy. Teaching the child and parent how to perform and track home PEF helps quantify control, reveal day-to-day variability, assess adherence and inhaler technique, and uncover patterns related to triggers or symptoms. This data guides whether to adjust anti-inflammatory therapy, address adherence or technique, or modify environmental factors. Without objective data, simply increasing ICS or overemphasizing rescue inhaler use may be inappropriate or ineffective. Home PEF monitoring sets up a plan to monitor response to any future change and tailor therapy accordingly.