An 18-year-old man was diagnosed with allergic asthma when he was 12 years old. He recently began attending college outside his home state and presents to you for the first time today. The patient's history is notable for seasonal allergic rhinitis, peanut allergy, and overweight (he is 5'11" and weighs 208 lb; BMI = 29.0). He also has a history of hospitalizations due to asthma exacerbations (approximately 1 per year), with the most recent one occurring 3 months ago; however, he attributes that to playing basketball outside during high pollen season. The patient's current medications include a medium-dose inhaled corticosteroid (ICS)-long-acting beta agonist (LABA), a reliever medication for asthma symptoms, and combination intranasal corticosteroid-antihistamine as needed for allergic rhinitis.

At today's visit, the patient's FEV1 is < 60% predicted. He describes his current level of asthma control as good. When questioned, he reports nighttime awakenings due to asthma symptoms about once a week and asthma symptoms most days, but he states that his reliever medication works well and he is satisfied with his current level of control.