<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 21-year-old man presents to his physician with a cough that has persisted for 4 weeks. His cough is usually nocturnal and awakens him from sleep. He denies having a fever, but was diagnosed with asthma when he was 15 years old and uses inhaled albuterol for relief of his symptoms. He usually needs to use a rescue inhaler once or twice a month. However, over the last 4 weeks, he has had to use inhaled albuterol almost daily. He does not have symptoms such as sneezing, running nose, nasal congestion, nasal discharge, headache, nausea, vomiting, regurgitation of food, or burning in the epigastrium. On physical examination, his temperature is 36.8C 98.4F, pulse rate is 96min, blood pressure is 11680 mm Hg, and respiratory rate is 16min. On auscultation of the chest, end-expiratory wheezing is present bilaterally. The peak expiratory flow rate PEFR is 74 of that expected for his age, sex, and height. Which of the following is the best next step in the treatment of this patient?? A: Use inhaled albuterol 4 times daily and follow up after 4 weeks., B: Add daily inhaled formoterol to the current regimen., C: Add daily inhaled ipratropium bromide to the current regimen., D: Add daily inhaled corticosteroids to the current regimen., E: Add daily oral levocetirizine to the current regimen.,  <response>: This is a patient with worsening asthma symptoms over the past 4 weeks, as evidenced by increased use of albuterol rescue inhaler and decreased PEFR. The choices include adding various asthma controller medications like long-acting beta-agonists formoterol, anticholinergics ipratropium, inhaled corticosteroids, and antihistamines levocetirizine. The key here is that the patient has persistent asthma symptoms requiring daily albuterol use despite already being on a rescue inhaler. This indicates poor asthma control and the need to step up maintenance therapy. Inhaled corticosteroids are the most effective anti-inflammatory therapy for persistent asthma and the cornerstone of treatment. Therefore, adding an inhaled corticosteroid is the best next step.D: Add daily inhaled corticosteroids to the current regimen. 