E

Well-done! Montelukast is a leukotriene receptor antagonist (LTRA), which works by blocking the cysteinyl leukotrienes involved in airway inflammation, bronchoconstriction, and mucus secretion.

Further developments

Amy has been doing relatively well on her drug regimen. However, over the last few days, she began feeling unwell due to an upper respiratory tract infection.  Trying not to let this get her down, she decides to go for a drink with her boyfriend Dave at a local pub. Amy suddenly begins experiencing difficulty breathing. She notices chest tightness, making it harder to take a deep breath, wheeze, which both she and Dave can hear, shortness of breath and a persistent cough, which makes it difficult to complete sentences. Having forgotten her inhaler at home, her symptoms only worsen, and she feels increasingly anxious and lightheaded. Dave takes Amy to the Emergency Department, where a diagnosis of mild acute asthma exacerbation, likely triggered by the upper respiratory tract infection, is reached.

Treatment is initiated promptly with oxygen, nebulized salbutamol and intravenous hydrocortisone. Amy’s symptoms gradually improve. While Amy’s symptoms resolve in the Emergency Department, the attending physician explains that another drug will need to be prescribed to manage Amy.

What other drug should be added, for a short period, after resolving the acute asthma attack?