If a patient with moderate persistent asthma continues to require a rescue inhaler daily despite treatment, what is the most appropriate next step?

In the context of managing moderate persistent asthma, if a patient is still requiring their rescue inhaler daily despite being on a standard treatment regimen, it indicates that their asthma is not well controlled. In this situation, the most appropriate next step is to consider adding omalizumab (Xolair).

Omalizumab is a monoclonal antibody that targets IgE, which is involved in allergic responses and can contribute to asthma exacerbations. It is specifically beneficial in patients with persistent asthma who have elevated IgE levels and is typically used in cases where traditional therapies have proven ineffective. By adding omalizumab, you can help to control the underlying inflammatory processes that contribute to asthma symptoms and reduce the frequency of exacerbations.

This approach aligns with asthma management guidelines that suggest stepping up therapy for patients who are not adequately controlled with their current regimen. Other options, such as switching to oral corticosteroids or increasing the dose of inhaled corticosteroids, are generally considered when more standard dosing does not lead to control, but they may not target the underlying issue as effectively as omalizumab would in certain patients.