Rosh Pediatrics Practice Exam

In the management of asthma, what is the best next step for a 13-year-old with recurrent cough and wheezing after a cold?

1. Prescribe a 5-day course of azithromycin

2. Prescribe an as-needed low-dose inhaled corticosteroid

3. Reassure the parents that the symptoms should resolve on their own

4. Recommend daily dosing with an albuterol inhaler

The correct answer is: Prescribe an as-needed low-dose inhaled corticosteroid

In the management of asthma, especially in a patient who is experiencing recurrent cough and wheezing after a viral illness, the use of an as-needed low-dose inhaled corticosteroid is appropriate. Inhaled corticosteroids are the mainstay of asthma treatment, helping to reduce inflammation in the airways and prevent exacerbations. For a 13-year-old with recurrent symptoms, it's vital to address the underlying inflammation that may be contributing to the asthma. An as-needed low-dose inhaled corticosteroid can provide targeted relief and help in controlling symptoms more effectively compared to short-acting bronchodilators alone. This approach is particularly important since the child’s symptoms follow a respiratory infection, which often exacerbates asthma. In contrast, prescribing azithromycin is not recommended unless there is clear evidence of a bacterial infection, as antibiotics do not treat viral illnesses or asthma itself. Reassuring the parents without any intervention does not address the child’s symptoms and could lead to increased morbidity. Daily dosing with an albuterol inhaler is not appropriate, as albuterol is a short-acting bronchodilator meant for quick relief of symptoms, not for daily control or prevention of asthma symptoms. Effective asthma management focuses on reducing airway inflammation and maintaining control, which is best