A 45-year-old patient with asthma on beclometasone 100 mcg/dose, 2 puffs twice daily, and frequent SABA use has poor control. What is the next step in treatment?

• A. Switch to MART
• B. Increase inhaled corticosteroid dose
• C. Add leukotriene receptor antagonist
• D. Start oral corticosteroids

Answer: (A)

When asthma remains poorly controlled despite a low-dose inhaled corticosteroid and frequent reliever use, the best next step is to switch to maintenance and reliever therapy with an ICS-formoterol inhaler. This approach delivers anti-inflammatory treatment every time you inhale, not just on a scheduled basis, and provides fast relief with the same inhaler. With each puff, you get both bronchodilation and anti-inflammatory effects, which helps reduce symptoms and lowers the risk of severe exacerbations compared with using a separate rescue inhaler and a separate maintenance regimen. The pattern also decreases reliance on the short-acting beta-agonist, addressing the problem of overuse. If MART isn’t possible, increasing the ICS dose or adding other agents can be considered, but they don’t address the issue of providing anti-inflammatory therapy at every relief dose as effectively as ICS-formoterol used as both maintenance and rescue.