**Question:** Most common mode of treatment of a 1 year old child with asthma is -

A. Salbutamol (SABA) inhaler
B. Montelukast (Leukotriene Receptor Antagonist, LTRA)
C. Fluticasone (Corticosteroid) inhaler
D. Salbutamol (SABA) + Budesonide (Corticosteroid) combination inhaler

**Correct Answer:** D. Salbutamol (SABA) + Budesonide (Corticosteroid) combination inhaler

**Core Concept:** In the treatment of asthma in children, especially for infants like a 1-year-old, a combination therapy is often used to provide both short-acting bronchodilator (SABA) and long-acting bronchodilator (LABA).

**Why the Correct Answer is Right:** This is because a combination of Salbutamol (short-acting beta2-agonist) and Budesonide (corticosteroid) offers several advantages over single drug therapy:

1. **Budesonide (Corticosteroid)**: Corticosteroids are potent anti-inflammatory agents that help suppress the inflammatory response in the airways, reducing bronchoconstriction and airway hyperresponsiveness, thereby improving lung function.

2. **Salbutamol (Short-Acting Beta2-agonist)**: Salbutamol is a potent bronchodilator, which directly relaxes the airway smooth muscle, leading to bronchodilation and improvement in respiratory symptoms.

**Why Each Wrong Option is Incorrect:**

A. Salbutamol (SABA) and Montelukast (Leukotriene Receptor Antagonist, LTRA) combination: Montelukast is a leukotriene receptor antagonist (LTRA), used to reduce inflammation and prevent asthma exacerbations. However, it lacks the direct bronchodilator effect of Salbutamol, which is necessary for immediate relief of asthma symptoms.

B. Salbutamol (SABA) and Budesonide (Corticosteroid) combination: Although both Salbutamol and Budesonide are effective in asthma management, using them together does not provide the immediate relief (as with Salbutamol) and the anti-inflammatory effect (as with Budesonide) simultaneously.

C. Salbutamol (SABA) and Fluticasone (Corticosteroid): Similar to option B, this combination does not provide the immediate relief and anti-inflammatory effect simultaneously.

D. Salbutamol (SABA) + Budesonide (Corticosteroid): This combination provides both the immediate relief (Salbutamol) and the long-term anti-inflammatory effect (Budesonide), making it an effective treatment choice for a 1-year-old child with asthma.

**Clinical Pearl:** In children, the use of a combination of a short-acting beta-agonist (e.g., Salbutamol) and a corticosteroid (e.g., Budesonide) is