For asthma management at Step 1, which medication is indicated?

• A. Short-acting beta2 agonists
• B. Inhaled low-dose glucocorticoids
• C. Long-acting beta2 agonists
• D. Montelukast

Answer: (A)

Short-acting beta2 agonists are the go-to therapy at Step 1 because this step covers intermittent asthma, where the main need is quick relief of symptoms as they occur. A rescue inhaler provides rapid bronchodilation within minutes to relieve bronchospasm during an attack and does not require daily controller medication. Inhaled low-dose corticosteroids are daily controllers used for persistent asthma, so they’re not appropriate for Step 1. Long-acting beta2 agonists are maintenance medications for persistent symptoms and are not used alone at Step 1. Montelukast is a leukotriene receptor antagonist that may be used as an alternative or add-on in some persistent or milder cases, but it isn’t the first-line rescue therapy for Step 1. Therefore, the rescue short-acting beta2 agonist is indicated.