Figure. Stepped approach to adjusting asthma medication 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