A 55-year-old man with asthma is on high-dose ICS, LABA, and LTRA and has had two severe exacerbations requiring oral steroids in the last three months. What is the most appropriate next step?

• A. Increase ICS dose
• B. Refer to a specialist in asthma care
• C. Add biologic therapy
• D. Stop LTRA

Answer: (B)

When asthma remains uncontrolled despite high-dose inhaled corticosteroids with a long-acting beta-agonist and an oral leukotriene receptor antagonist, and there have been multiple severe exacerbations, specialist input is needed. This pattern points to severe asthma that may require more advanced evaluation and targeted therapy. A specialist can confirm the diagnosis, assess adherence and inhaler technique, review triggers and comorbidities, and perform tests (such as eosinophil counts, IgE levels, FeNO, and detailed spirometry) to characterize the asthma phenotype. If appropriate, they can discuss add-on biologic therapies (for example anti-IL-5/IL-5R or anti-IgE agents) tailored to the patient’s inflammatory profile. Increasing the ICS dose further is unlikely to yield meaningful benefit at this stage and carries more risk, while starting biologic therapy or stopping LTRA should follow specialist assessment.