<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 42-year-old woman comes to the physician for a follow-up appointment. Two months ago, she was diagnosed with asthma after a 1-year history of a chronic cough and dyspnea with exertion. Her symptoms have improved since starting inhaled albuterol and beclomethasone, but she still coughs most nights when she is lying in bed. Over the past 2 weeks, she has also had occasional substernal chest pain. She does not smoke. She is 158 cm 5 ft 2 in tall and weighs 75 kg 165 lb; BMI is 30 kgm2. Vital signs are within normal limits. She has a hoarse voice and frequently clears her throat during the examination. The lungs are clear to auscultation. Pulmonary function tests show a FEV1 of 78 of expected. Which of the following is the most appropriate next step in management?? A: Order a transthoracic echocardiogram, B: Add a salmeterol inhaler, C: Add oral prednisone, D: Add a proton pump inhibitor, E: Order total serum IgE levels,  <response>: This is a patient with asthma who is not fully controlled on her current inhalers. She has new symptoms of chest pain and throat clearinghoarse voice. The key findings are:- Partially controlled asthma with nocturnal symptoms - New onset chest pain could suggest GERD- Hoarse voice and throat clearing could suggest reflux laryngitis- Obesity which increases risk of GERDSo this suggests GERD as a cause of her uncontrolled asthma and new symptoms. The choices include asthma medications B, C and cardiac testing A which are not indicated at this time. Choice E tests total IgE which may be elevated in asthma but does not help guide management here. Choice D to add a PPI for presumed GERD is most appropriate next step.D: Add a proton pump inhibitor 