Sally, a 9-year-old with moderate persistent asthma, is still having mild symptoms. You alter this treatment to include which of the following?

Sally, a 9-year-old with moderate persistent asthma, is still having mild symptoms. You alter this treatment to include which of the following?

• A. Broad spectrum antibiotic
• B. Addition of systemic corticosteroid x5 days
• C. Replace cromolyn with inhaled corticosteroid, and decrease the beta agonist to PRN when symptoms subside
• D. Addition of an inhaled anticholinergic

Answer: (C)

In persistent asthma, the primary goal is to control airway inflammation with an inhaled corticosteroid as the regular controller therapy. Cromolyn is an older option that is less effective for most children with moderate persistent asthma, so replacing it with an inhaled corticosteroid targets the underlying inflammation and tends to provide better and more consistent control. Once control improves, it’s appropriate to step down the use of the beta-agonist to PRN (as needed) when symptoms are not present, rather than continuing a daily, fixed schedule for the bronchodilator. This aligns treatment with the current level of control—maintain anti-inflammatory therapy to keep symptoms at bay, and use the bronchodilator only as needed for breakthrough symptoms. Broad-spectrum antibiotics aren’t indicated for routine asthma management unless there’s a bacterial infection. Systemic corticosteroids are reserved for acute exacerbations or severe flare-ups, not as routine management for a child with moderate persistent asthma who has only mild symptoms. An inhaled anticholinergic is not a first-line controller for persistent asthma in children and is not typically added in this scenario.

In persistent asthma, the primary goal is to control airway inflammation with an inhaled corticosteroid as the regular controller therapy. Cromolyn is an older option that is less effective for most children with moderate persistent asthma, so replacing it with an inhaled corticosteroid targets the underlying inflammation and tends to provide better and more consistent control.

Once control improves, it’s appropriate to step down the use of the beta-agonist to PRN (as needed) when symptoms are not present, rather than continuing a daily, fixed schedule for the bronchodilator. This aligns treatment with the current level of control—maintain anti-inflammatory therapy to keep symptoms at bay, and use the bronchodilator only as needed for breakthrough symptoms.

Broad-spectrum antibiotics aren’t indicated for routine asthma management unless there’s a bacterial infection. Systemic corticosteroids are reserved for acute exacerbations or severe flare-ups, not as routine management for a child with moderate persistent asthma who has only mild symptoms. An inhaled anticholinergic is not a first-line controller for persistent asthma in children and is not typically added in this scenario.