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Why not option A
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Why novotion a
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asthma AND corticosteroids
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GINA 2025 asthma oral corticosteroids maintenance low dose inhaled corticosteroid treatment
Option A, oral prednisolone 10 mg daily, is not appropriate because this patient does not have a severe acute exacerbation or severe treatment-resistant asthma.
She has partly controlled asthma:
- Night-time symptoms once weekly
- Reliever use twice weekly
- FEV1 improves with bronchodilator, indicating reversible airflow obstruction
The appropriate next step is to add a controller medication, specifically an inhaled corticosteroid (ICS). Therefore, among these options, C: fluticasone propionate 40 micrograms twice daily is best.
Why avoid long-term oral prednisolone here:
- It is systemic corticosteroid treatment, reserved for a short course during significant exacerbations or, rarely, as a last-resort maintenance treatment in severe asthma.
- Daily oral prednisolone causes substantial cumulative toxicity: weight gain, diabetes, hypertension, osteoporosis, cataracts, adrenal suppression, infection risk, and mood effects.
- An ICS targets airway inflammation directly with far fewer systemic effects.
So the logic is:
Partly controlled asthma on SABA alone → add low-dose inhaled steroid, not daily oral steroid.
Also, B and D are wrong because SABA-only treatment does not treat the underlying airway inflammation, and scheduled salbutamol can promote over-reliance on reliever therapy. Current GINA guidance similarly says maintenance oral corticosteroids should be only a last resort because of serious systemic adverse effects, while asthma treatment should contain an inhaled corticosteroid. GINA asthma guidance
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