Asthma: What next when your patient does not respond to therapy

A number of key steps can be taken to identify factors that may be interfering with your patient's response to asthma therapy. The most obvious initial steps are to confirm that the diagnosis of asthma is correct and that the patient has been receiving therapy based on published guidelines, which emphasize the early use of inhaled anti-inflammatory agents for all patients except those with mild, intermittent asthma. Carefully assess the degree to which the patient is adhering to the prescribed regimen. Poor understanding of the benefits of medications may lead to noncompliance with antiinflammatory therapy. Make sure that the patient is carefully taught how to use a metered-dose inhaler (MDI), and periodically assess his or her MDI technique. Also evaluate potential aggravating factors, such as allergens and other exposures, sinusitis, and gastroesophageal reflux disease.