Most people with asthma are told that a daily preventer inhaler will keep them well, and for many it does. But a large share of people on treatment still wake at night, reach for their rescue inhaler several times a week, or end up on a course of prednisone after a bad flare. In one study of more than 15,000 treated US patients, about 3 in 10 had asthma that was not well controlled, and the share rose to 45 percent among those on the most intensive treatment. Uncontrolled asthma is not a personal failing, and it often improves: it usually has a cause that can be found. This guide explains how to tell whether your asthma is controlled, what the Asthma Control Test score means, the most common reasons a preventer inhaler is not enough, and the next steps, including research for people at exactly this point.
Using a preventer inhaler and still having flare-ups?
These studies are testing new options for people like you.
What uncontrolled asthma means
Asthma control describes how much asthma affects your life right now: daytime symptoms, waking at night, how often you need your rescue inhaler, and whether asthma limits what you do. International guidance from the Global Initiative for Asthma (GINA) also looks at future risk, and the strongest warning sign there is a flare-up in the past year serious enough to need oral steroids or a hospital visit. Asthma can be uncontrolled at any severity. Someone with moderate persistent asthma who uses their inhaler incorrectly can be poorly controlled, while someone with severe asthma on the right treatment can be well controlled.
Our guide to asthma treatment options explains the treatment steps.
The signs are practical: symptoms more than twice a week, waking at night with cough or wheeze, using a rescue inhaler such as albuterol more than twice a week, activity limited by breathing, or any flare-up that needed prednisone or emergency care. If you recognize one or more of those while taking a combination inhaler every day, your treatment is not doing its full job.
Your Asthma Control Test score: what the number means
The Asthma Control Test is five questions about the past four weeks, and it takes about a minute. Scores range from 5 to 25, with higher being better. A score of 20 to 25 means asthma is well controlled; 16 to 19 means not well controlled; and 5 to 15 means very poorly controlled. A change of 3 points or more is considered meaningful, which makes it a useful way to track whether a treatment change is working. Many doctors' offices use it, and you can ask for it at your next visit. If your score is 19 or below while you are on a daily preventer, that is the signal to look for the reason.
Why your inhaler may not be enough
Inhaler technique. GINA reports that up to 80 percent of people in the community use their inhalers incorrectly, which means much of the medicine never reaches the lungs. Having a nurse or pharmacist watch you use it is one of the most effective changes you can make, and it costs nothing.
Taking it less often than prescribed. Preventer inhalers work only when used every day, including on good days. Missed doses are one of the most common reasons for poor control.
Triggers and other conditions. Smoking or vaping, allergens at home or work, acid reflux, chronic sinus disease, obesity, and sleep apnea can all keep asthma active despite treatment.
The treatment step is too low. When technique, adherence, and triggers have been addressed and asthma is still uncontrolled, the treatment itself usually needs to change. That is when the next steps below come in.
What comes next when a combination inhaler is not enough
Doctors follow stepped care. Common next steps include switching to an approach where a combination inhaler containing formoterol is used both daily and as the rescue inhaler, raising the dose of the inhaled steroid, or adding a third type of inhaler medicine called a long acting muscarinic antagonist. When asthma remains uncontrolled despite a high dose combination inhaler taken correctly, GINA defines it as severe asthma, and referral to a specialist for assessment of biologic injections is the next step. Repeated courses of oral steroids are worth avoiding where possible, because their side effects add up over time; if you have needed several in a year, that alone is a reason to ask for a review. Never stop or change an inhaler without talking to your doctor.
A practical warning: if your rescue inhaler is not relieving an attack, or you are breathless while speaking, that is an emergency and needs immediate care.
Why this is the point where asthma research looks for participants
New asthma treatments are tested in people whose asthma is still active despite standard treatment, because that is where a new medicine has to prove it adds something. Many studies therefore enroll adults with moderate or severe asthma who already use a combination inhaler, have had their diagnosis for at least a year, and have had flare-ups recently, sometimes ones that needed oral steroids. They usually exclude current smokers, people with a significant smoking history, people with COPD or other lung diseases, and people already on a biologic, because each of those would change the result. If you are in the gap between your current inhaler and a biologic, you are often exactly who these studies need.
How to find an asthma study
AllClinicalTrials.com lists asthma studies recruiting across the US, and you can filter by location before applying. Right now that includes three studies for adults with moderate or severe asthma who still have symptoms on a combination preventer inhaler, such as Advair, Symbicort, or Breo. The application takes about 5 minutes: you answer questions about your diagnosis, inhalers, and recent flare-ups, and if a study near you looks like a match, the research team contacts you. Nothing is decided until you have gone through informed consent, and participation is voluntary at every step. Our asthma clinical trials page lists more studies.
Three things to have ready: the name of your preventer inhaler, how many times in the past year you needed oral steroids, an emergency visit, or a hospital stay for asthma, and your Asthma Control Test score if you know it.
Common questions
What is uncontrolled asthma? Asthma that still causes frequent symptoms, night waking, frequent rescue inhaler use, activity limits, or flare-ups needing steroids, despite treatment. It can happen at any severity and usually has a cause that can be found.
What Asthma Control Test score means uncontrolled? A score of 19 or below. Scores of 16 to 19 mean not well controlled, and 5 to 15 mean very poorly controlled; 20 to 25 is well controlled.
Why is my asthma not controlled with my inhaler? Most often because of inhaler technique, missed doses, ongoing triggers such as smoking or allergens, or other conditions like reflux or sinus disease. If those are addressed and it is still uncontrolled, the treatment step usually needs to change.
What is the difference between moderate and severe asthma? Moderate asthma is controlled with a low or medium dose combination inhaler. Severe asthma stays uncontrolled despite a high dose combination inhaler used correctly, or needs that level of treatment or a biologic to stay controlled.
How many prednisone courses a year is too many? Any course for asthma is a sign of a flare-up, and needing more than one in a year is a strong reason to review treatment with your doctor, because side effects of oral steroids add up even over a few courses in a lifetime
Do asthma trial participants get paid? Some studies offer compensation for time and travel, and study related care is typically provided at no cost to participants. Compensation varies by trial and is always described during the informed consent process before you agree to anything.
See Asthma clinical trials recruiting now
Browse open studies, filter by location, and apply in about 5 minutes: Asthma Clinical Trials.