Inhaled steroids for asthma

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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

An 8yo patient with history of mild intermittent asthma comes in with an acute exacerbation that clears readily with 1 treatment of nebulized albuterol. The patient has had 2 similar ED visits in the last 3 months. The patient has an albuterol MDI for home use, but no spacer. The patient is not on any controller medications. The respiratory therapist has taught the patient/parents how to use the MDI properly with a spacer, and you are discharging the patient home.