Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the third step in asthma management?

1. SABA + ICS + oral corticosteroids

2. SABA + ICS + leukotriene inhibitor

3. SABA + LABA + ICS

4. SABA + ICS + long-acting anticholinergics

The correct answer is: SABA + ICS + leukotriene inhibitor

In the context of asthma management, the third step typically involves adding a leukotriene receptor antagonist to the treatment regimen, which is reflected in the stated answer. This approach is important for patients whose asthma is not well controlled with just a short-acting beta-agonist (SABA) and inhaled corticosteroid (ICS). Leukotriene receptor antagonists work by inhibiting the action of leukotrienes, which are inflammatory mediators involved in the pathophysiology of asthma. By incorporating a leukotriene inhibitor, the treatment strategy addresses the underlying inflammation and bronchoconstriction that can persist despite initial therapy. Thus, this step represents a balanced method aimed at achieving better control of asthma symptoms and reducing the frequency of exacerbations. The other approaches listed, while helpful in various scenarios, do not align with the typical stepwise escalation for asthma management at this specific stage. For example, the use of oral corticosteroids is generally reserved for more severe exacerbations, and the combination of long-acting bronchodilators varies based on individual patient needs and previous treatments. Thus, the inclusion of a leukotriene inhibitor in this third step reflects well-established guidelines for managing asthma, leading to improved outcomes for patients requiring a more nuanced