If albuterol is insufficient in controlling asthma symptoms, which medication should be added next?

In the management of asthma, if a short-acting beta agonist like albuterol is not providing adequate control of symptoms, the next step typically involves adding a medication that will offer more sustained control of inflammation and airway hyperreactivity.

Inhaled corticosteroids are considered the first-line maintenance therapy for moderate to severe asthma and work by reducing airway inflammation and hyperresponsiveness over time. They have a strong evidence base supporting their effectiveness in improving lung function, decreasing the frequency of asthma exacerbations, and enhancing overall asthma control. By addressing the underlying inflammation that contributes to asthma symptoms, inhaled corticosteroids can help provide long-term control when short-acting bronchodilators alone are insufficient.

While options like long-acting beta agonists and leukotriene inhibitors are also effective in asthma management, they are often used in conjunction with inhaled corticosteroids for optimal control. Oral corticosteroids are typically reserved for severe exacerbations or as a short-term measure in acute situations due to their systemic side effects.

Therefore, the most appropriate next step after albuterol in this context is to add an inhaled corticosteroid, which targets the primary issue in asthma—airway inflammation.