In a patient with active worsening asthma requiring additional therapy, what class of medication should be considered next?

In a patient experiencing active worsening asthma, systemic corticosteroids are the recommended class of medication to consider next. This is primarily because systemic corticosteroids are highly effective in rapidly reducing inflammation and controlling exacerbations of asthma. They work by suppressing the immune response and decreasing airway inflammation, which is crucial during an asthma exacerbation when patients typically experience increased airway reactivity and narrowing.

While short-acting beta agonists provide immediate relief of bronchoconstriction and are essential for managing acute symptoms, they do not address the underlying inflammation driving the exacerbation. Long-acting beta agonists, although useful in a maintenance role for asthma control, are not suitable for acute management on their own and should not be used without inhaled corticosteroids for long-term control. Inhaled corticosteroids, while important in the long-term management of asthma, take time to have an effect and are not sufficient for addressing acute exacerbations on their own.

Systemic corticosteroids, on the other hand, can provide a prompt and effective response to inflammation and are indicated when a patient’s asthma is not adequately controlled with other medications during an exacerbation. Utilizing systemic corticosteroids in these situations is a critical part of managing worsening asthma and improving patient outcomes.