A 28-Year-Old Primigravid Woman at 20 Weeks Gestation Comes to the Office

A 28-year-old primigravid woman at 20 weeks gestation comes to the office for asthma follow-up.  Her asthma has been managed with combination mometasone-formoterol for relief as needed.  She has never been hospitalized for asthma.  Prior to pregnancy, the patient used a reliever inhaler no more than 1 or 2 times per month.  However, over the past 2 months, she has used her inhaler several days per week.  The patient also reports occasionally awakening at night with cough and wheezing.  She denies any specific asthma triggers and does not own any pets.
Temperature is 36.7 C (98 F) , blood pressure is 110/70 mm Hg, pulse is 84/min, and respirations are 16/min.  Pulse oximetry is 96% on room air.  The patient is not in acute distress and is breathing comfortably.  Lung examination demonstrates good air entry with scattered expiratory wheezing bilaterally.
Results of spirometry are as follows:
Which of the following is the most appropriate pharmacotherapy?

A) Add daily tiotropium to the current regimen
B) Continue the current regimen without changes
C) Give a 7-day oral prednisone taper
D) Schedule mometasone-formoterol twice daily
E) Switch to fluticasone-salmeterol as needed

Correct Answer:

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