If albuterol is not effective, what is the next step in asthma management?

• A. Increase albuterol dose.
• B. Add inhaled corticosteroid.
• C. Stop therapy.
• D. Switch to oral antibiotics.

Answer: (B)

When a quick-relief inhaler no longer controls asthma symptoms, the focus shifts from immediate bronchodilation to reducing the underlying airway inflammation with a regular controller medication. The standard next step is to start an inhaled corticosteroid, which is the first-line anti-inflammatory controller therapy for persistent asthma. This addresses the inflammation that drives symptoms and decreases the frequency and severity of attacks over time. Increasing the albuterol dose isn’t appropriate because it ups the dose of a bronchodilator without treating inflammation and can cause side effects like tremor and tachycardia, and may mask poor control. Stopping therapy would remove protection and risk a severe flare, and switching to antibiotics isn’t relevant since asthma is not an infection-driven disease. Adding inhaled corticosteroids targets the root problem and improves long-term control.