If you’re still coughing or wheezing despite using a low‑dose inhaler, it’s time to think about step‑up therapy. This isn’t about swapping meds randomly; it’s a structured plan doctors use to tighten control and keep attacks away.
The first sign is frequent daytime symptoms—more than twice a week—or night waking because of breathlessness. Another clue is needing your rescue inhaler more than two times a month. If you’ve hit those markers, ask your doctor about moving to the next step.
Age matters too. Kids and teens often need lower doses, while adults may jump straight to a combo inhaler. Your overall health, allergy triggers, and how well you follow the current plan all shape the decision.
The most popular step‑up is adding an inhaled corticosteroid (ICS) to your existing short‑acting bronchodilator. If you’re already on a low‑dose ICS, the next move could be upping that dose or switching to a combination inhaler with a long‑acting beta‑agonist (LABA). Many people find a once‑daily combo like fluticasone/salmeterol works well and cuts down the number of puffs.
For those who can’t tolerate higher steroids, doctors might add a leukotriene receptor antagonist (LTRA) such as montelukast. It’s a pill you take at night and can help with both asthma and allergic rhinitis.
Severe cases sometimes need biologic drugs—injectable treatments that target specific inflammation pathways. These are usually reserved for people who still have attacks despite high‑dose inhalers and oral steroids.
Whatever combo you end up on, the key is regular follow‑up. Your doctor will check lung function, symptom diaries, and rescue inhaler use every few months to see if the step‑up is working or if you can scale back later.
In practice, keep a simple log: note when you use your rescue inhaler, any triggers, and how you feel each day. This data makes it easier for both of you to decide whether to stay at the new level, move higher, or try stepping down once control is solid.
Remember, step‑up therapy isn’t a punishment; it’s a tool to give your lungs the support they need. By acting early and following a clear plan, you can enjoy more active days with fewer interruptions from asthma.
