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  • Hello Dr. One of my asthma patients has been on  LABA/ICS  for some time, but is not responding. What do I do?
  • Hi Dr. Amit.  Are you sure the diagnosis is Asthma? 
  • The patient was referred to me from one of the tertiary centers with the diagnosis
  • Then I would suggest to send him for spirometry and confirm the diagnosis
  • Sometimes it may be difficult to differentiate on the basis of history alone.
  • The diagnosis of COPD is often missed. The hallmark is FEV1/FVC<0.7
  • But what difference will it make? Wouldn't the treatment still be LABA/ICS?
  • Not necessary. Currently the GOLD guidelines consider LABA/LAMA as a preferred option in most categories
  • ICS is preferred only in case of exacerbations. Moreover, chances of pneumonia are much higher with ICS
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