How should I adjust the management plan for a patient with asthma who is experiencing frequent exacerbations despite adherence to their current treatm

Consider reviewing and addressing possible reasons for uncontrolled asthma before further treatment adjustments, such as checking inhaler technique, adherence, and environmental factors ¹.

If control remains suboptimal, consider increasing the dose of inhaled corticosteroids (ICS) or adding a long-acting beta-2 agonist (LABA) or other controller medications, based on individual assessment ¹.

Assess for risk factors for exacerbations, including SABA overuse, recent oral corticosteroid courses, and environmental triggers, and modify management accordingly ¹.

Use a personalised asthma action plan to guide early recognition and response to worsening symptoms, including when to escalate treatment or seek urgent care ¹.

Review inhaler technique and adherence at every consultation, and consider fractional exhaled nitric oxide (FeNO) monitoring to evaluate adherence and inflammation, if available ¹.

If frequent exacerbations persist despite optimized pharmacotherapy, consider referral to a specialist for further assessment and possible escalation of treatment, including biologic therapies if indicated ¹.