Which of the following is considered long-term management in patients with persistent bronchial asthma?

RML PRE 2025

Pharmacology

Easy

Appeared in: RML PRE 2025

Explanation

Inhaled corticosteroids (ICS) are the first-line and cornerstone therapy for the long-term control of persistent asthma.
They are anti-inflammatory agents that reduce airway hyperresponsiveness, prevent exacerbations, and improve overall lung function.
Direct inhalation minimizes systemic absorption and associated side effects, making them safer for long-term use compared to oral steroids.

Option A: Short-acting β₂ agonists are 'reliever' or 'rescue' medications. They treat acute symptoms (bronchospasm) but do not control the underlying chronic inflammation characteristic of persistent asthma.
Option B: Long-term use of oral steroids is associated with numerous and severe systemic side effects (e.g., osteoporosis, diabetes, weight gain, immunosuppression). They are not used for routine long-term management.
Option D: Oxygen therapy does not treat the underlying pathophysiology of asthma (inflammation and bronchoconstriction). It only addresses the symptom of hypoxemia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological management of persistent bronchial asthma as background academic context rather than a clinical decision trigger.
Patient education is a critical nursing responsibility. Nurses must teach patients the difference between controller (preventer) and reliever (rescue) medications to ensure proper self-management and prevent over-reliance on rescue inhalers, which is a sign of poor asthma control.
Nurses should instruct patients using inhaled corticosteroids to rinse their mouth after each use to prevent local side effects like oral thrush (candidiasis).
What if? If a patient with persistent asthma reports using their short-acting β₂ agonist more than twice a week for symptoms, it indicates their asthma is not well-controlled. The nurse should recognize this and facilitate a review of their long-term controller therapy, which may need to be 'stepped up' (e.g., by increasing the ICS dose or adding a long-acting beta-agonist).

How to Approach the Question

First, identify the key phrase in the question: 'long-term management'. This asks for a medication used daily to prevent symptoms, not one used to treat an acute attack.
Next, analyze the term 'persistent bronchial asthma'. This signifies a chronic inflammatory condition that requires ongoing anti-inflammatory treatment.
Evaluate each option based on its role in asthma care:
Short-acting β₂ agonist: This is a 'rescue' drug for acute symptoms.
Oral steroids: These are for severe, acute flare-ups, not routine long-term care due to side effects.
Oxygen therapy: This is an emergency measure for severe attacks with low oxygen.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 p. 129-131

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1415-1417