A 6-year-old boy is referred by his pediatrician to the allergy clinic for asthma unresponsive to therapy with inhaled steroids and montelukast. He has had asthma symptoms since the age of 6 months and has been on multiple inhaled medications. His mother gives him a dose of nebulized aerosol every morning so that he can play and remain active during the day. The last time he had night symptoms was 2 months ago. He has been hospitalized with shortness of breath 4 times in the last 2 years, never intubated.
He has been to the ER 3 times in the last year and was given prednisone during the last visit 1 month ago. Past medical history (PMH) Asthma, allergic rhinitis. Skin prick testing positive for House Dust Mite, mold, grass, trees (2 years ago). Family History Father with asthma as a child Medications Fluticasone propionate/ salmeterol 250/50 bid, Montelukast daily. Physical examination…
