The correct answer is B. This patient has mild persistent asthma. Low dose Inhaled steroids should be the mainstay of therapy to maintain remission between asthmatic episodes in a patient with mild persistent asthma. They effectively reduce airway inflammation, whereas the beta-2 agonist inhalers are more effective for short-term relief of symptoms. The most likely side effect you would find on the boards from steroid inhalers is the development of oral candidiasis, which can be prevented by prompt mouth rinsing after inhaler use.
Aminophylline (choice A) has no role in the maintenance therapy of asthma and has very limited use during an acute attack as well.
Cromolyn (choice C) is not effective in maintaining remissions. However, it is useful as a prophylactic measure before initiating exercise in those patients whose trigger for bronchoconstriction is exercise.
A metaproterenol inhaler (choice D) is of value in reducing symptoms during an acute attack but is not effective in preventing relapses.
Oral prednisone (choice E) is effective in preventing relapses but is reserved for patients who have had severe refractory asthmatic attacks and should not be used for patients with a milder course.
PEARL: The preferred controller medication in patients with mild persistent asthma is a low dose inhaled steroid which can reduce the frequency symptoms and the need for short-acting beta agonists. Low dose inhaled steroids also improve the quality of life and reduce the risk of serious exacerbations. Low dose inhaled steroids do NOT prevent progressive loss of lung function.
Mild Intermittent Asthma is characterized by the following:
- Daytime asthma symptoms occurring 2 or fewer days per week
- 2 or fewer nocturnal symptoms per month
- Use of short-acting beta agonists fewer than twice weekly
- No interference with normal activities between exacerbations
- FEV1 measurements between exacerbations that are consistently within the normal range (ie, ≥80 percent of predicted normal)
- FEV1/FVC ratio between exacerbations that is normal (based on age-adjusted values)
- One or less exacerbations per year requiring oral glucocorticoids
Mild Persistent Asthma is characterized by the following:
- Symptoms more than twice weekly (although less than daily)
- 3 to 4 nocturnal symptoms per month
- Use of short-acting beta agonists to relieve symptoms more than twice weekly (but not daily)
- Minor interference with normal activities
- FEV1 measurements within normal range (≥80 percent of predicted normal)
- FEV1/FVC ratio is normal (based on age-adjusted values)
- 2 or more exacerbations per year requiring oral glucocorticoids
Moderate persistent Asthma is characterized by the following:
- Daily symptoms of asthma
- Nocturnal symptoms more than once per week
- Daily use of short-acting beta agonists for symptom relief
- Some limitation in normal activity
- FEV1 between 60 and 80 percent of predicted
- FEV1/FVC reduced below normal (based on age-adjusted values)
- 2 or more exacerbations per year requiring oral glucocorticoids
Severe Persistent Asthma is characterized by one or more of the following:
- Symptoms of asthma throughout the day
- Nocturnal symptoms nightly
- Use of short-acting beta agonists for symptom relief several times per day
- Extreme limitation in normal activity
- FEV1 <60 percent of predicted
- FEV1/FVC reduced below normal (based on age-adjusted values)
- 2 or more exacerbations per year requiring oral glucocorticoids
