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

Figure. Stepped approach to adjusting asthma medication in adultsStepping down treatment in adults Stepping down treatment in adults Stepping up treatment in adults Stepping up treatment in adults Stepping up treatment in adults Stepping up treatment in adults Planning and conducting asthma review in adults Table. Guide to selecting and adjusting asthma medication in adults and older adolescents Table. Initial treatment choices (adults not already using a preventer) Table. Definitions of ICS dose levels in adults Table. Definition of levels of recent asthma symptom control in adults and older adolescents (regardless of current treatment regimen)

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.
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. (This combination is not classed as a reliever when used in a maintenance-only regimen).

§ In addition, manage flare-ups with extra treatment when they occur, and manage exercise-related asthma symptoms as indicated.

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