An 18-Year-Old Man Comes to the Office for a Follow-Up

An 18-year-old man comes to the office for a follow-up for asthma.  He is a member of his college hockey team and practices daily.  He has a history of seasonal allergies that required immunotherapy during childhood.  About a month ago, he had an acute asthma exacerbation during a game and was subsequently hospitalized; before the game, the patient had an upper respiratory illness with cough, rhinorrhea, and shortness of breath requiring frequent use of a rescue inhaler.  In the hospital, he improved quickly with intravenous corticosteroids and nebulized albuterol.  He was discharged with a 10-day tapering-dose course of oral corticosteroids, which he finished 2 weeks ago, and as-needed inhaled albuterol.  The patient has been taking prophylactic albuterol prior to games and practice but continues to have wheezing and chest tightness with exercise and exposure to cold air.  He often has to take more than one dose of albuterol during a prolonged practice or game and wants to know how to prevent future attacks.
On physical examination, the lungs are clear to auscultation.  Spirometry reveals an FEV1 of 92% predicted and an FEV1/FVC ratio of 85%.  Chest radiograph shows no hyperinflation or infiltrates.
Which of the following is the most appropriate preventive intervention for this patient?

A) Add daily loratadine
B) Add daily montelukast
C) Add daily salmeterol
D) Add daily theophylline
E) Advise him to avoid exercising in cold environments