Your patient tells you that she is having chest tightness and wheezing four to six times per week,plus she wakes up with chest tightness and wheezing about once per week.She uses albuterol each time,with relief.She is taking no other medication except her albuterol MDI.What other medication would you suggest be prescribed to her?

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The patient exhibits no clinical signs of infection that would call for an antibiotic such as tobramycin (and if she did,tobramycin is unsuitable for oral administration because of its high first-pass effect).Because she is already taking a bronchodilator,the National Asthma Education and Prevention Program (NAEPP)guidelines call for the addition of an inhaled steroid.General clinical indications for use of inhaled corticosteroids are as follows: · Orally inhaled agents: Maintenance control therapy of chronic asthma,identified as step 2 care or greater by the NAEPP Expert Panel Report 2 Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics. · Step 2 asthma: Symptoms more than 2 days per week but less than once a day or symptoms more than 2 nights per month with forced expiratory volume in 1 second (FEV₁)or peak expiratory flow (PEF)80% predicted or greater but PEF variability at 20-30%. · Inhaled agents can be used together with systemic corticosteroids in severe asthma and may allow systemic dose reduction or elimination for asthma control.

Your Patient Tells You That She Is Having Chest Tightness