CLINICAL QUESTION

In adolescents and adults with uncontrolled asthma who are already taking a medium-dose inhaled corticosteroid (ICS), what are the effectiveness and safety of adding a long-acting beta₂ agonist (LABA) or a long-acting muscarinic antagonist (LAMA) vs. doubling the dose of the ICS compared with continuation of the medium-dose ICS?

EVIDENCE-BASED ANSWER

Adding a LABA to a medium- or high-dose ICS likely reduces the frequency of moderate to severe asthma exacerbations compared with continuing a medium-dose ICS alone.¹ (Strength of Recommendation [SOR]: A, consistent, good-quality patient-oriented evidence.)

Adding a LAMA to a medium-dose ICS possibly reduces the frequency of moderate to severe asthma exacerbations compared with continuing a medium-dose ICS alone.¹ (SOR: A, consistent, good-quality patient-oriented evidence.)

A high-dose ICS alone likely does not reduce the frequency of moderate to severe asthma exacerbations compared with a medium-dose ICS alone.¹ (SOR: B, inconsistent or limited-quality patient-oriented evidence.)