In mild persistent asthma, which pharmacologic step is recommended?

In mild persistent asthma, which pharmacologic step is recommended?

• A. Short-acting beta-agonist as needed only
• B. Add low-dose inhaled corticosteroid
• C. Long-acting beta-agonist monotherapy
• D. Daily systemic corticosteroids

Answer: (B)

The key idea is that mild persistent asthma requires regular control of airway inflammation, not just relief of symptoms. Daily inhaled corticosteroids provide that anti-inflammatory control, reducing symptoms and the risk of exacerbations over time. Short-acting beta-agonists used only as needed treat bronchospasm but do not address the underlying inflammation, so relying on them alone is inadequate for persistent disease. Using a long-acting beta-agonist by itself is unsafe in asthma and is not recommended; it should be combined with an anti-inflammatory agent if used. Daily systemic corticosteroids are reserved for severe, uncontrolled disease due to significant systemic side effects. Therefore, adding daily low-dose inhaled corticosteroids is the best approach for mild persistent asthma.

The key idea is that mild persistent asthma requires regular control of airway inflammation, not just relief of symptoms. Daily inhaled corticosteroids provide that anti-inflammatory control, reducing symptoms and the risk of exacerbations over time. Short-acting beta-agonists used only as needed treat bronchospasm but do not address the underlying inflammation, so relying on them alone is inadequate for persistent disease. Using a long-acting beta-agonist by itself is unsafe in asthma and is not recommended; it should be combined with an anti-inflammatory agent if used. Daily systemic corticosteroids are reserved for severe, uncontrolled disease due to significant systemic side effects. Therefore, adding daily low-dose inhaled corticosteroids is the best approach for mild persistent asthma.