Asthma Management Handbook
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Figure. Stepped approach to adjusting asthma medication in adults and adolescents

AdultManageTable. Guide to selecting and adjusting asthma medication for adults and older adolescents Table. Definitions of ICS dose levels in adults Table. Initial treatment choices (adults and adolescents not already using a preventer) Table. Definition of levels of recent asthma symptom control in adults and adolescents (regardless of current treatment regimen) Table. Risk factors for adverse asthma outcomes in adults and adolescents

Before considering stepping up, check symptoms are due to asthma, inhaler technique is correct, and adherence is adequate
Consider stepping up if good control is not achieved despite good adherence and correct inhaler technique.
When asthma is stable and well controlled for 2–3 months, consider stepping down (e.g. reducing inhaled corticosteroid dose, or stopping long-acting beta2 agonist if inhaled corticosteroid dose is already low).

ICS: inhaled corticosteroid; SABA: short-acting beta2 agonist; LABA: long-acting beta2 agonist

* Reliever means rapid-onset beta2 agonist and includes:

  • short-acting beta2 agonists
  • low-dose budesonide/formoterol combination – only applies to patients using this combination in a maintenance-and-reliever regimen (steps 3 and above). This combination is not classed as a reliever when used in a maintenance-only regimen. 

§ At all steps: review recent symptom control and risk regularly. Manage comorbidities and individual risk factors. Manage flare-ups with extra treatment when they occur. Manage exercise-related asthma symptoms as indicated. 

†  Medium dose as maintenance, low dose as reliever.


Last reviewed version 2.0

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Asset ID: 31