MSFinals-4101

A 6-year-old boy is brought to the GP surgery by his mother. He has a two-year history of asthma which has previously been controlled with a salbutamol inhaler twice daily and beclomethasone 50 micrograms bd. He has an audible wheeze that has been gradually worsening over the last few weeks and has not responded to additional doses of salbutamol. His mother also reports that he has a night-time cough for the past 6 weeks.

What is the most appropriate next step in management?