PEBC MCQ Asthma, COPD & Smoking Cessation question: asthma on budesonide-formoterol maintenance and reliever therapy

PEBC MCQAsthma, COPD & Smoking Cessation

RE, 33, has asthma on budesonide-formoterol maintenance and reliever therapy. During a cold she has used 10 reliever inhalations a day for 2 days, is short of breath walking and her peak flow is 55% of her best. What does her action plan most likely advise?

a. Add montelukast and continue the current reliever use
b. Switch the reliever to salbutamol and keep the controller dose
c. Double her maintenance inhalations and wait 2 weeks before seeing anyone
d. Start a short course of oral prednisone and contact her doctor today

Show the answer and explanation

Answer: d. Start a short course of oral prednisone and contact her doctor today

In budesonide-formoterol maintenance and reliever therapy, the total daily use should generally not exceed 8 inhalations (12 for short periods), and a peak flow below about 60% of personal best with escalating need signals a moderate-to-severe exacerbation needing a short course of oral corticosteroid and same-day medical review. Waiting 2 weeks, swapping relievers or adding montelukast does not treat an exacerbation of this severity. Source: CTS asthma guideline 2021 update, written action plans (Can J Respir Crit Care Sleep Med 2021;5:348); budesonide/formoterol (Symbicort) product monograph, maximum daily inhalations (DPD, checked 2026).

Common mistake

Continuing to escalate reliever use instead of starting oral steroids and seeking care.

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