What step-up therapy should be provided for a 14-year-old boy with poorly controlled asthma currently on a low-dose ICS?

For a 14-year-old boy with poorly controlled asthma currently on a low-dose inhaled corticosteroid (ICS), the recommended step-up therapy involves adding a long-acting beta2-agonist (LABA) to the existing treatment regimen. This approach aligns with current asthma management guidelines, which suggest that patients who are not achieving adequate control with a low-dose ICS should have a LABA included in their therapy regimen.

Adding a LABA helps to improve lung function and reduce symptoms by providing sustained bronchodilation over an extended period. It works synergistically with inhaled corticosteroids, enhancing control of asthma by addressing both inflammation (from ICS) and bronchoconstriction (from LABA).

In this scenario, simply switching the ICS to a different medication, such as an oral corticosteroid, might lead to unwanted systemic side effects and does not directly address the current asthma management goals of better symptom control and preventive care. Additionally, omalizumab, while effective for patients with moderate to severe allergic asthma, is not typically the first line for step-up therapy unless there's a strong indication for allergic components or severe asthma that isn't managed by other medications.

Thus, adding a LABA to the current low-dose ICS represents a prudent and evidence-based step