Recurrent Wheeze and Chest Tightness

🗒️ Question

A 24 year old man presents to his GP with a history of recurrent episodes of wheezing, shortness of breath and chest tightness which occur approximately three times per week. His symptoms are worse at night and are often triggered by exercise. He has no significant medical history and does not smoke.

On examination, his respiratory rate is 20 breaths per minute, his pulse rate is 88 bpm and his oxygen saturation is 98% on room air. Bilateral expiratory wheeze is heard on auscultation.

What is the most appropriate initial management?

(A) High dose inhaled corticosteroid

(B) Inhaled corticosteroid with long-acting beta-agonist

(C) Leukotriene receptor antagonist

(D) Low dose inhaled corticosteroid

(E) Oral prednisolone