For persistent severe asthma in children over 12, what treatment should be combined with high dose ICS?

The treatment for persistent severe asthma in children over 12 typically involves a combination of medications to achieve optimal control of the condition. In this scenario, the combination of a long-acting beta-agonist (LABA) and oral corticosteroids is appropriate when dealing with severe asthma that is not adequately controlled with high-dose inhaled corticosteroids (ICS) alone.

Oral corticosteroids are effective in providing a quick reduction in inflammation and bronchoconstriction during exacerbations. They help manage symptoms and improve lung function when patients are experiencing more severe asthma symptoms despite being on high-dose ICS. The addition of a LABA further aids in bronchodilation, providing prolonged relief of symptoms.

This combination is often recommended in treatment guidelines for severe asthma, not only to manage current symptoms but also to help prevent future exacerbations. The LABA acts as a maintenance therapy alongside the inflammatory control of the oral corticosteroids.

In contrast, other options such as low-dose ICS or medium-dose ICS do not provide the necessary level of treatment intensification required for persistent severe asthma. While a LABA alone is beneficial, it is also essential to provide systemic inflammatory control, which is why the combination with oral corticosteroids is appropriate. Thus, the use of both a LABA