In a patient with asthma requiring step-up therapy, which option describes the role of an inhaled corticosteroid such as Beclometasone in management?

• A. Short-acting bronchodilator alone
• B. Inhaled corticosteroid as controller therapy
• C. Systemic corticosteroid only
• D. Leukotriene receptor antagonist only

Answer: (B)

Inhaled corticosteroids provide ongoing anti-inflammatory control in persistent asthma. Beclometasone, delivered by inhalation, acts directly in the airways to reduce inflammatory cells and edema, decrease airway hyperresponsiveness, and prevent symptoms when used regularly. This makes it the main maintenance or controller therapy in step-up management, aiming to keep asthma well-controlled and reduce the need for rescue bronchodilators. Short-acting bronchodilators address only immediate symptoms and do not treat the underlying inflammation. Systemic corticosteroids are reserved for short-term use during severe exacerbations, while leukotriene receptor antagonists can be used as add-ons in some cases but do not replace inhaled corticosteroids as the primary controller. Beclometasone’s inhaled form concentrates in the lungs with minimal systemic exposure, though attention to technique and oral rinsing helps minimize local side effects like thrush.