An asthma patient with inhaled corticosteroid, montelukast, and a SABA presents with mild expiratory wheezes after assessment. What should the nurse do next?

• A. Question the patient about how much albuterol has been used
• B. Administer systemic glucocorticoids immediately
• C. Increase montelukast dosage
• D. Switch to an inhaled corticosteroid

Answer: (A)

Assessing how much rescue inhaler the patient has used is the key step. The frequency of albuterol use is the most informative clue about current asthma control, because a patient should only need a reliever inhaler for intermittent symptoms. If the patient is relying on albuterol frequently, it suggests inadequate control despite existing controller therapy (inhaled corticosteroid and montelukast) and raises concern for a potential exacerbation or ongoing airway inflammation. By asking about albuterol use, you gauge severity, adherence, and inhaler technique, and you can determine whether to reinforce correct use and adherence or consider stepping up maintenance therapy.

Systemic glucocorticoids would be reserved for a more significant or escalating exacerbation rather than mild wheezes. Increasing montelukast or switching to more ICS isn’t the immediate move without first assessing rescue inhaler use and overall control, since the patient already has a controller regimen in place. If concern persists after evaluating albuterol use, you can then address potential dose adjustments, technique, and triggers as part of a broader plan.