Presentation

You are part of a team of medical students on a clinical placement in a general practice clinic. The attending physician asks you to see Amy, a 23-year-old woman, who has come in with a history of recurrent wheezing and troublesome cough over the past two years. Amy works as an interior designer, often spending long hours working on-site and in newly renovated spaces. She reports that her symptoms tend to worsen in the winter months, with cold air making her feel breathless during her morning commute. She also reports experiencing frequent nasal congestion and sneezing during spring. She mentions that her colleagues often comment on the strong fumes from paints, solvents, dust, and cleaning agents at construction sites, and admits that these seem to trigger her chest tightness and coughing.

In the past six months, Amy has experienced monthly episodes of wheezing and shortness of breath. She has also begun to notice some wheezing and tightness in her chest after vigorous exercise, such as jogging or climbing stairs, which she attributes to a "lack of fitness."

Between episodes, Amy generally feels well, with no significant daytime symptoms.However, she notices occasional coughing at night, which sometimes wakes her up.

Her past medical history includes eczema since childhood, which is currently well-controlled with emollients. Her father suffers from asthma, and her mother has seasonal allergic rhinitis.

Following further examination and investigations, a diagnosis of mild asthma is reached.

Which drug or combination of drugs would you prescribe for Amy?