A 28-year-old man with well-controlled asthma on low-dose inhaled corticosteroid presents with persistent nocturnal cough and awakening 4 nights per week due to wheezing. Vital signs: BP 118/76, HR 82, RR 16, SpO2 98% on room air. Daytime symptoms are minimal with no acute dyspnea. FEV1 is 82% predicted. Chest radiograph is normal. Which of the following changes would be most appropriate?

  1. A)Switch to a higher dose of inhaled corticosteroid monotherapy
  2. B)Refer to sleep medicine for obstructive sleep apnea evaluation
  3. C)Add a long-acting beta-2 agonist to the regimenGABARITO
  4. D)Discontinue inhaled corticosteroid and use only albuterol as needed
  5. E)Recommend smoking cessation and allergy testing only

Explicação

Nocturnal symptoms occurring 4 nights per week indicate persistent moderate asthma despite low-dose ICS monotherapy. Guidelines recommend adding a long-acting beta-2 agonist (LABA) to ICS for step-up therapy, providing 24-hour bronchodilation and preventing ni... Ver explicação completa e trilha adaptativa →

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