Consider reviewing and addressing possible reasons for uncontrolled asthma before further treatment adjustments, such as checking inhaler technique, adherence, and environmental factors NICE CKS.
If control remains suboptimal, consider increasing the dose of inhaled corticosteroids (ICS) or adding a long-acting beta-2 agonist (LABA) or other controller medications, based on individual assessment NICE CKS.
Assess for risk factors for exacerbations, including SABA overuse, recent oral corticosteroid courses, and environmental triggers, and modify management accordingly NICE CKS.
Use a personalised asthma action plan to guide early recognition and response to worsening symptoms, including when to escalate treatment or seek urgent care NICE CKS.
Review inhaler technique and adherence at every consultation, and consider fractional exhaled nitric oxide (FeNO) monitoring to evaluate adherence and inflammation, if available NICE CKS.
If frequent exacerbations persist despite optimized pharmacotherapy, consider referral to a specialist for further assessment and possible escalation of treatment, including biologic therapies if indicated NICE CKS.