A school-aged child has episodic wheeze and reversible obstruction on spirometry. Which condition is diagnosed, and what is the recommended first-line daily controller therapy?

• A. Asthma; leukotriene receptor antagonist daily with SABA rescue.
• B. Asthma; inhaled corticosteroids (low-dose) daily with a short-acting beta-agonist (SABA) for rescue.
• C. Chronic cough with no reversibility; inhaled corticosteroids daily with no rescue inhaler.
• D. Bronchiolitis; antibiotics and bronchodilators.

Answer: (B)

Episodic wheeze with reversible airway obstruction on spirometry points to asthma, a chronic inflammatory airway disease where symptoms wax and wane but can improve with treatment. In school-aged children, the first-line daily controller therapy is a low-dose inhaled corticosteroid to reduce airway inflammation and prevent symptoms and exacerbations. A short-acting beta-agonist inhaler is used as rescue therapy to quickly relieve bronchospasm during symptoms.

Leukotriene receptor antagonists can be used in some cases as an alternative or add-on, but they’re not the preferred first-line daily controller when inhaled corticosteroids are tolerated. The other options don’t fit because chronic cough with no reversibility isn’t asthma, and bronchiolitis is a younger, typically viral problem not treated with routine antibiotics and bronchodilators.