What is a likely consequence of poor adherence to inhaled corticosteroids (ICS) in asthma management?

• A. No change in symptoms.
• B. Immediate improvement in FEV1.
• C. Long-term adverse effects are inevitable.
• D. Exacerbations and poor control due to ICS nonadherence.

Answer: (D)

Inhaled corticosteroids are long-term controller meds that suppress airway inflammation. They don’t provide immediate relief like rescue inhalers, and their beneficial anti-inflammatory effects build up with consistent use over time. When adherence is poor, the inflammation remains active, so asthma control worsens, leading to more symptoms, nighttime awakenings, reduced lung function, and a higher risk of exacerbations that may require systemic steroids or urgent care.

That’s why the most likely consequence of ICS nonadherence is exacerbations and poor control. Statements about immediate improvements in FEV1 with nonadherence aren’t realistic, and while ICS have potential side effects, those aren’t inevitable simply because someone isn’t taking them consistently.