In pediatric asthma, which clinical features indicate the need for stepping up therapy?

• A. No nocturnal symptoms
• B. Frequent symptoms, nighttime awakenings, activity limitation
• C. Only exercise-induced symptoms
• D. Normal growth velocity

Answer: (B)

The key idea here is recognizing when asthma in a child is not well controlled and needs stronger controller therapy. When a child experiences frequent daytime symptoms, nighttime awakenings, and limits for activity, these together show ongoing airway inflammation and impaired daily function, signaling that stepping up treatment is needed to regain control and reduce risk of exacerbations.

Nocturnal symptoms, if absent, point toward good control, and symptoms that occur only with exercise can often be managed with strategies limited to that context (sometimes using a quick-relief inhaler before activity) without necessarily increasing daily controller therapy. Normal growth velocity also suggests good overall control with no adverse systemic effects from treatment.