Choosing Wisely:

Avoid stepping up asthma therapy (adding new drugs or going to higher doses) before assessing adherence, appropriateness of device, and technique with current asthma medications.

Rationale and Comments: The 2007 Expert Panel report from the National Asthma Education and Prevention Program discusses in detail the importance of monitoring asthma control in pediatric patients, stepping up therapy, and stepping down therapy, when appropriate. There are key evaluations that should occur before stepping up therapy. Providers should first review with the family how they are administering the present asthma medications to determine whether the asthma controller is being administered properly and effectively for the age of the patient. Another evaluation is to confirm adherence both by discussion with the family and learning the refill history from the pharmacy. It is also important to explore other barriers to adherence for the patient and family. There is no reason to step up to a higher-dose steroid inhaler or to a combination therapy if the patient is not receiving the lower-dose asthma controller with the correct technique and frequency.
Sponsoring Organizations:
  • N/A
  • Sources:
  • National Asthma Education and Prevention Program guideline
  • Disciplines:
  • Pulmonary medicine
  • Pediatric
  • References: • National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Heart, Lung, and Blood Institute; 2007.
    • Weinberger M. Asthma. In: Light M, ed. Pediatric Pulmonology. Elk Grove Village, IL: American Academy of Pediatrics; 2011:250-261.
    • Yawn BP. The role of the primary care physician in helping adolescent and adult patients improve asthma control. Mayo Clin Proc. 2011;86(9):894-902.

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