What is the recommended therapy for a patient whose asthma control has worsened despite adherence to medication?

The recommended therapy for a patient whose asthma control has worsened despite adherence to medication is a daily medium-dose inhaled corticosteroid (ICS), along with a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), with a short-acting beta-agonist (SABA) available as needed for acute relief.

This combination therapy is effective for patients whose asthma remains uncontrolled while using lower doses of ICS or other treatment options. The addition of a LABA enhances bronchodilation and reduces the frequency of asthma exacerbations, while the LAMA can provide additional benefits in terms of long-term control, particularly in patients with more severe or persistent symptoms. The SABA serves as a rescue medication for symptomatic relief during acute asthma attacks.

While increasing the dose of ICS can be considered, it is essential to include a LABA and possibly a LAMA for a more comprehensive approach to managing persistent asthma, especially when control has already declined. Switching to oral corticosteroids is typically a more aggressive step and may indicate severe asthma exacerbation, but it can lead to significant side effects and is generally not the first option when optimizing therapy for persistent asthma control.