QuestionSBA
QuestionChoice
This is the final step in the guidelines, and is only used when all treatments have failed to control a patient's symptoms. With this patient only being on step two of the drug treatment for asthma, it would not be appropriate to refer for specialist management.
10000638
c
Refer for specialist treatments
QuestionChoice
Oral steroids are only used in patients with chronically poorly-controlled asthma. This is also a hospital-directed treatment so would only occur under specialist supervision. Additionally, the next step in this patient's treatment is the initial add-on therapy of a LABA e.g. salmeterol, not altering his steroid inhaler dosage or type.
10000640
e
Switch inhaled beclometasone to low-dose oral prednisolone
QuestionChoice
Montelukast is a Leukotriene Receptor Antagonist (LTRA), which may be used as an additional controller therapy in this patient. However, the initial add-on therapy used in the current guidelines is an inhaled LABA e.g. salmeterol. If this was then found to not work, then an LTRA may be used instead.
10000639
d
Add oral montelukast to his existing drug regime
QuestionChoice
This patient's asthma symptoms are not being appropriately controlled with a regular inhaled corticosteroid (Beclometasone) and SABA (Salbutamol). Therefore, he should move onto the next step of treatment. The BTS/SIGN 2019 guidelines direct us to add a LABA inhaler, such as Salmeterol, to his existing inhalers - and to continue this treatment if he has a good response.
10000636
a
Add a salmeterol inhaler to his existing drug regime
QuestionChoice
We should follow the current BTS/SIGN guidelines and first prescribe an inhaled LABA, e.g. salmeterol, in addition to his current drug regime, before making any changes to his ICS inhaler dose. Changing his beclometasone dose would only be indicated if initial add-on therapies (e.g. salmeterol) failed to control his symptoms.
10000637
b
Increase the beclometasone inhaler to a high-dose inhaled corticosteroid inhaler
Concept
Chapter
2693
3725
Asthma
Topic
132
Respiratory
12674
A 24-year-old male, previously diagnosed with asthma, presents with repeated episodes of dyspnoea and wheezing. He uses both a salbutamol inhaler and a low-dose beclometasone inhaler one to two times daily.

Which of the following is the most appropriate next step in the management of this patient?
a