What pharmacologic agent should be added for a 12-year-old asthmatic girl with worsening symptoms and frequent nocturnal awakenings?

In the case of a 12-year-old asthmatic girl experiencing worsening symptoms and frequent nocturnal awakenings, adding a medium-dose corticosteroid is appropriate. This choice is grounded in the understanding that inhaled corticosteroids (ICS) are the cornerstone of asthma management due to their efficacy in reducing airway inflammation, improving lung function, and minimizing asthma symptoms.

Frequent nocturnal awakenings indicate that the asthma is poorly controlled, suggesting that the current management strategy needs a stronger anti-inflammatory approach. Medium-dose corticosteroids help manage persistent asthma by reducing airway inflammation, preventing exacerbations, and improving overall asthma control. They are especially important in addressing the underlying pathophysiology of asthma, which involves chronic inflammation and hyperresponsiveness of the airways.

Inhaled corticosteroids are universally recommended for children with moderate persistent asthma or those who require treatment with a rescue inhaler more than twice a week. By increasing the dosage of corticosteroids, the girl's asthma control will likely improve, leading to better symptom management and fewer nighttime awakenings.

Other pharmacologic agents, such as short-acting beta-agonists, are primarily used for immediate relief of acute symptoms but do not address the underlying inflammation. Long-acting beta-agonists are typically combined with