A 35-year-old female presents to your pharmacy requesting advice on managing her asthma. She uses her salbutamol inhaler approximately 3-4 times per week for shortness of breath. She does not have nocturnal symptoms. She has no known allergies. What is the most appropriate initial recommendation for her asthma management?

Question: A 35-year-old female presents to your pharmacy requesting advice on managing her asthma. She uses her salbutamol inhaler approximately 3-4 times per week for shortness of breath. She does not have nocturnal symptoms. She has no known allergies. What is the most appropriate initial recommendation for her asthma management?

Answer options:

• Continue salbutamol as needed and monitor.
• Add a low-dose inhaled corticosteroid (ICS) daily. ✅ Start a combination inhaler of low-dose ICS/formoterol as reliever and maintenance.
• Refer to a respirologist immediately.

Correct answer: Start a combination inhaler of low-dose ICS/formoterol as reliever and maintenance.

Explanation: According to Canadian Thoracic Society (CTS) guidelines, in patients with persistent asthma symptoms (e.g., SABA use >2 times/week), low-dose ICS-formoterol as both reliever and maintenance therapy is recommended as initial controller therapy. This approach has been shown to be superior to SABA-only or daily ICS with SABA taken as needed.