Patient description: A 39-year-old man came to the clinic with cough and shortness of breath that was not relieved by his inhaler. He had these symptoms for 5 days during the past 2 weeks. He doubled his oral corticosteroids in the past week. He is a chef with a history of asthma for 3 years, suffering from frequent cough, wheezing, and shortness of breath and chest tightness. The symptoms become more bothersome within 1-2 hours of starting work every day and worsen throughout the work week. His symptoms improve within 1-2 hours outside the workplace. Spirometry was performed revealing a forced expiratory volume in the first second (FEV1) of 63% of the predicted. His past medical history is significant for seasonal allergic rhinitis in the summer. He doesn't smoke or use illicit drugs. His family history is significant for asthma in his father and sister. He currently uses inhaled corticosteroid (ICS) and fluticasone 500 mcg/salmeterol 50 mcg, one puff twice daily.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Asthma for and TALC Studies Clinical history consistent with asthma Forced expiratory volume in one second (FEV1) greater than 40% of predicted value Asthma confirmed by one of the following two 1. Beta-agonist reversibility to 4 puffs albuterol of at least 12% OR 2. Methacholine provocative concentration at 20% (PC20) FEV1 of 8 milligrams per millimeter (mg/mL) or less when not on an inhaled corticosteroid, or 16 mg/mL or less when on an inhaled corticosteroid Need for daily controller therapy (i.e., inhaled corticosteroids, leukotriene modifiers, and/or long-acting beta-agonists) based on one or more of the following 1. Received prescription for or used asthma controller within the 12 months prior to study entry OR 2. Experienced symptoms for more than twice a week and not on asthma controller If on inhaled steroids (any drug at any dose not exceeding the equivalent of 1000 micrograms (mcg) of fluticasone daily), participant must have been on a stable dose for at least 2 weeks prior to study entry Non-smoker (i.e., total lifetime smoking history less than 10 pack-years; no smoking for at least 1 year prior to study entry) Willing to use an effective form of birth control throughout the study for Study Ability to measure peak expiratory flow (PEF) each morning using the electronic peak flow meter (EPFM) device and to accurately transcribe the PEF measurements onto the diary cards at least 75% of the time during the last 2 weeks of the adherence testing period compliance with recording peak flow measurements and symptoms in a symptom diary during the last 2 weeks of the adherence testing period  for and TALC Studies Lung disease other than asthma, including chronic obstructive pulmonary disease (COPD) and chronic bronchitis Established or suspected diagnosis of vocal cord dysfunction Significant medical illness other than asthma History of respiratory tract infection within the 4 weeks prior to study entry History of a significant exacerbation of asthma within the 4 weeks prior to study entry History of life-threatening asthma requiring treatment with intubation and mechanical ventilation in the 5 years prior to study entry Hyposensitization therapy other than an established maintenance regimen Inability to coordinate use of the delivery devices used in the study, based on the opinion of the investigator or clinical coordinator Pregnant