If a patient on LABA/LAMA therapy is not improving, what is the next recommended step?

In patients who are not experiencing improvement while on LABA (long-acting beta agonist) and LAMA (long-acting muscarinic antagonist) therapy, the next recommended step is to add ICS (inhaled corticosteroids) to the treatment regimen. This approach is based on the understanding that LABA and LAMA therapies primarily provide bronchodilation and symptom relief, but may not sufficiently address underlying inflammation that can contribute to chronic obstructive pulmonary disease (COPD) or asthma exacerbations.

Adding ICS helps to reduce airway inflammation and, in many cases, can lead to significant improvements in lung function and symptom control. This step is particularly beneficial in patients who have frequent exacerbations or who have underlying inflammatory processes that require corticosteroid treatment for better management of their condition.

By incorporating ICS, healthcare providers can provide a more comprehensive approach to managing respiratory conditions, aiming to improve overall patient outcomes and reduce the frequency of exacerbations.