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Chapter 28 – Asthma (QE) Sample Questions

1. FD, a 7-year-old child, was taken to the emergency room late at night by his parents because of a severe cough. FD’s history was taken upon admission and his parents reported that they have taken FD to his pediatrician for urgent care twice for the last 3 months due to chest tightness that caused FD to breathe with difficulty. His mom also reports recurrent whistling or rattling sound in FD’s chest. Based on her presentation her pediatrician determines mild infrequent exercise induced asthma and normal spirometry. What is the initial management for FD?

A. Salbutamol 100 mcg/puff 2 puffs TID -QID as needed and provide action plan for asthma control
B. Salbutamol 100 mcg/puff 2 puffs TID -QID plus low dose ICS and provide action plan for asthma control
C. Salbutamol 100 mcg/puff 2 puffs TID -QID plus montelukast 5 mg chewable and provide action plan for asthma control
D. Salbutamol 100 mcg/puff 2 puffs TID -QID plus montelukast 10 mg oral and provide action plan for asthma control

Answer

Ans: A

Tips: NEW GINA GUIDELINES: currently, for children >12 years ICS/LABA (Symbicort) PRN is recommended for acute/first step asthma, however for <12 years Salbutamol remains current preferred treatment. Thus A) is still right option. (In the future it is likely this will change)…

“As such, the new GINA report has removed SABAs as the first step in asthma management for children >12 years of age and adults, and encourages the earlier use of an inhaled corticosteroid (ICS). While this was not formally added to the guidelines for younger children (<6 y) at the time of publication, this message is becoming more applicable to younger children.” (eCPS, 2022)

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