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What is the most likely first prescription for a patient newly diagnosed with asthma?

  1. fluticasone/salmeterol (Advair diskus) 250/50 BID PRN for shortness of breath

  2. salmeterol (Serevent) 50mcg inhaled daily

  3. albuterol (Xopenex) MDI PRN for wheezing

  4. montelukast (Singulair) 10mg PO daily

The correct answer is: albuterol (Xopenex) MDI PRN for wheezing

The most likely first prescription for a patient newly diagnosed with asthma is albuterol (Xopenex) MDI PRN for wheezing. This choice is appropriate because albuterol is a short-acting beta-agonist (SABA) and is commonly used as a rescue medication to provide quick relief of acute asthma symptoms. Inhalers containing albuterol are effective in relaxing bronchial smooth muscle, subsequently alleviating wheezing and shortness of breath during an asthma attack. When considering the management of asthma, it is crucial to provide patients with immediate relief for their symptoms, and albuterol serves this function reliably. This medication is typically used as needed, which aligns with its primary purpose in a newly diagnosed patient who may experience intermittent symptoms. It is essential to start with a SABA to ensure that patients have access to fast-acting relief for their immediate respiratory symptoms. Other options may involve corticosteroids or long-acting medications, which are more suited for ongoing asthma management rather than immediate symptom relief in newly diagnosed patients. While montelukast provides an alternative controller therapy, it is not the best first-line option for acute symptom management. Hence, albuterol is the most suitable choice for initial treatment.