Asthma showdown: which inhaler strategy wins?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Clinician diagnosis of asthma for ≥1 year; * Age at enrollment--18-75 years old inclusive; * One or more AEXs that occurred \< 12 months prior to enrollment. An AEX is defined as an asthma deterioration that either requires 72 hours or more of an oral or parenteral steroids OR a hospital stay for more than 24 hours for asthma. In the case of patients on biologics for asthma, the exacerbation must have also occurred after at least 6 months of biologic therapy; * Currently prescribed an ICS/LABA containing preparation containing at least the lowest dose of ICS described in Table 2 as regular daily maintenance therapy for at least one month; * Has a rescue SABA containing inhaler that they have used on average at least once a month. * Able to provide consent in English for the feasibility study or in English or Spanish for the full study. Exclusion Criteria: * Life expectancy \<2 years; * COPD diagnosis unless: a) they were a never smoker; OR b) former smoker with normal pulmonary function tests (PFT; FEV1/FVC ratio of \>70%); OR c) current smoker with normal PFTs within 24 months of enrollment; OR d) current or former smoker with obstruction on PFTs (FEV1/FVC ratio of \<70% but who demonstrates BOTH \>12% acute bronchodilator reversibility AND a normal diffusing capacity both within 24 months of enrollment (criteria successfully used in PREPARE); * Use of single inhaler product that contains an ICS, LAMA and LABA or one containing both LABA and LAMA within 1 month of enrollment; * Use of current biologic for less than 6 months; * Known allergy to any of the components of the intervention; * Coexisting lung disease (e.g. Cystic Fibrosis, connective tissue disease (unless asthma preceded diagnosis of connective tissue disease by at least 2 years), prematurity-born at 32 weeks or sooner, organ transplantation, bronchiectasis, sarcoid, and obliterative bronchiolitis, among others) * Has been in an asthma drug treatment trial in past 60 days or within 5 half-lives, whichever is longer, prior to study visit. * Living in household with someone already enrolled in the study. * Using daily or every other day oral corticosteroids for asthma or any other condition * An AEX in the prior 4 weeks * History of bronchial thermoplasty in prior 6 months * Poorly or uncontrolled atrial fibrillation * Not on stable asthma medications for at least 1 month prior to enrollment * Using doses of ICS/LABA lower than the minimum below: * Budesonide 320 ug, * Fluticasone Advair Diskus/ Wixela 200-250 ug Advair HFA 180-230ug Airduo 110-113 ug Breo 100 ug * Mometasone 200 ug