What medication should be added to an asthmatic patient on a SABA and ICS for better symptom control?

Adding Salmeterol, a long-acting beta agonist (LABA), to an asthmatic patient who is already using a short-acting beta agonist (SABA) and an inhaled corticosteroid (ICS) can significantly improve symptom control. LABAs are particularly effective for patients with persistent asthma as they provide extended bronchodilation, sustaining relief from symptoms for up to 12 hours or longer.

In combination with ICS, Salmeterol not only helps enhance airflow but also reduces the frequency of asthma exacerbations and the need for rescue inhaler use. This combination therapy effectively addresses inflammation while also providing prolonged bronchodilation, making it a preferred treatment approach for patients who remain symptomatic despite using SABA and ICS alone.

While other options such as Ipratropium bromide (an anticholinergic) can be beneficial for COPD or exacerbations, it is not the standard maintenance therapy for asthma. Montelukast, a leukotriene receptor antagonist, serves as an additional treatment option but may not provide as immediate or effective bronchodilation as a LABA would. Metaproterenol, like SABA, is a short-acting agent and would not effectively augment long-term control in the way that Sal