Acute Caremiddle twist
A 23-year-old university student is reviewed after being given a salbutamol inhaler by a locum six months ago. He uses it about three times most weeks for chest tightness when he plays football, and wakes coughing perhaps twice a month. He has never taken a preventer, has had no course of oral corticosteroid and has not been to hospital. He does not smoke. Spirometry shows a forced expiratory volume in one second of 78% predicted, rising to 92% after salbutamol. Which one of the following inhaled regimens should now replace his current treatment?