Key Points Underdiagnosis and inappropriate therapy are major contributors to asthma morbidity and mortality. Persistent asthma is most effectively controlled with daily anti-inflammatory therapy. Initiate therapy at a higher level at the onset to establish prompt control and then step down.
Continual monitoring is essential to ensure that asthma control is achieved.
Step down therapy cautiously once control is achieved and sustained. Step-down therapy is necessary to identify the minimum medication necessary to maintain control. At each step, patients should be advised to avoid or control allergens, irritants, or other factors that make the patient s asthma worse. Referral to an asthma specialist for consultation or comanagement is recommended if there are difficulties achieving or maintaining control of asthma or if the patient requires step 4 care. Referral may be considered for patients who require step 3 care.