Poor inhaler technique and missed doses are among the commonest reasons for uncontrolled asthma, and are easy to fix. Before escalating treatment or starting a biologic, watch the patient use their inhaler, check adherence and review triggers and comorbidities.
Ask the patient to demonstrate technique at each review, since technique decays over time.
- Watch the patient use the device and correct errors.
- Check pharmacy refill history for adherence.
- Review triggers such as smoke, allergens and drugs like aspirin or beta-blockers.
- Consider rhinitis, reflux and obesity as contributors to poor control.
- Confirm the diagnosis with spirometry before escalating.
Why it matters
Escalating treatment in someone who is not taking it correctly adds cost and risk without benefit.
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