Which of the following indicates a need for increased therapy?

Using a short-acting beta-agonist (SABA) more than two times per week is an important indicator of uncontrolled asthma and suggests that the current therapeutic regimen may not be adequately managing the patient's symptoms. SABAs are typically used for quick relief from acute asthma symptoms, and reliance on them more than twice a week indicates a potential increase in the frequency or severity of asthma symptoms.

In asthma management, the goal is to achieve control with the least amount of medication necessary. Regularly needing to use a SABA can signal that the underlying inflammation and airway hyperreactivity are inadequately controlled, thereby suggesting that a step-up in therapy is warranted, whether that involves increasing the dose of inhaled corticosteroids or considering the addition of other long-term control medications.

The other options reflect situations that usually indicate better asthma control. For instance, using a SABA less than once per week, having a forced expiratory volume in one second (FEV1) greater than 80%, and experiencing no nighttime symptoms are all markers of stable or controlled asthma. These factors are indicative of effective management and suggest that the current treatment is working well.