Hello Since you are an asthmatic patient and taking asthmanex, flotral ( foradil ) and ventolin . All these are bronchodilator and anti allergic . This indicate that you are having asthmatic allergic bronchitis and for your kind information this is a very common disorder in modern life due to so many allergen surrounding around us . These allergens are : Pollen , mite , fine dusting powder, sudden fall and rise of temperature , mold , pests ( cockroaches ) pets ( cats and dogs in home ) fumes , smoking ( active and passive ) . As all these are predisposing factors so avoidance help great. Do these measures : Wash all bed covers in hot cycle every week. Treat carpets w/acricides or tannic acid. Keep dust-accumulating objects in dust cup board. replace curtainswith blinds or easily washable curtains. Use vacuum cleaner , Encase mattress , pillows & quilts in impermeable covers. Install air- conditioner or dehumidifier . When such patient visit I only prescribe them to take montelukast+ bambuterol one or two tablet in day . All patients respond this treatment very nicely . No medicine except this. Hope this will help you. Take whenever necessary , stop once relief , recurs , use again. In my opinion there is no need of ER . Good luck.