Every Patient Leaves on an ICS
November 5, 2026
A clinical brief for referring providers — week 3 of a 4-part series on asthma exacerbations.
A question before the clinical note: A patient on ICS-formoterol MART is being discharged after an exacerbation. What should their rescue inhaler prescription be?
a) A standard SABA b) A SABA plus a spacer c) None
Dr. {{first_name}},
A patient finishes a short hospital stay for a severe exacerbation. Before this: albuterol alone, about two canisters a month, no controller.
One decision at discharge will do more to prevent his next admission than everything that preceded it. He does not go home on a rescue inhaler alone.
The discharge bundle
An ICS-containing regimen for every patient. Preferred for adults and adolescents is ICS-formoterol MART — GINA Track 1, Step 4 — which reduces future severe exacerbations and OCS need. Where MART is unavailable, medium-dose ICS-LABA for 2–4 weeks.
Reliever to as-needed. On ICS-formoterol, no separate rescue inhaler is needed.
Complete the OCS course, with stewardship.
A written action plan — interim now, finalized at follow-up.
Check inhaler technique and adherence before concluding the regimen failed.
Follow-up within 2–7 days.
Triggers, immunizations, modifiable risk factors.
Specialist referral for anyone hospitalized or repeatedly presenting.
Easy to miss: start the controller during the admission, not at the point of discharge.
At follow-up — reinforce the ICS and do not stop it, continue increased doses 2–4 weeks, and step down only after 2–3 months of stability.
Refer the patient who keeps coming back
Repeated presentations and any hospitalization both warrant specialist evaluation. We will confirm the diagnosis, assess technique and adherence properly, and build the controller regimen and action plan.
Call (847) 860-7250.
Sources: Reddel et al., GINA 2026; Skolnik et al., NPJ Primary Care Respiratory Medicine, 2024.
The answer
None. On ICS-formoterol MART, the reliever is the ICS-formoterol.