| Current treatment regimen | Adjustments when symptoms worsening (more frequent or more severe)* | ||
| Reliever dose | Maintenance dose | Systemic corticosteroid | |
AIR-only Budesonide-formoterol as needed | Principle: Increase by taking usual dose as needed. | Principle: ICS dose will automatically increase as patient uses more reliever doses | Principle: required to prevent severe exacerbation at onset of worsening symptoms beyond threshold set for individual patient based on risk and exacerbation history. Adults prednisone/prednisolone 37.5–50 mg within 1 hour of presentation, then each morning (total 5–10 days) Adolescents: prednisone/prednisolone 1 mg/kg (maximum 50 mg) orally once daily for 3 days. Sample instruction: Start prednisolone tablets if symptoms recur less than 4 hours after using reliever or symptoms do not improve after reliever. |
Sample instruction for patient using 200/6 microg as needed: Keep taking usual dose (1 inhalation) when symptoms occur. Repeat if symptoms do not improve or if symptoms recur. See doctor or go to the emergency department if you need more than 12 inhalations in one day. | Sample instruction: Keep taking usual daily dose(s). | ||
MART ICS-formoterol | Principle: Increase by taking usual dose as needed. | Principle: ICS dose will automatically increase as patient uses more reliever doses | |
Sample instruction: Keep taking usual dose when symptoms occur. Repeat if symptoms do not improve or if symptoms recur. See doctor or go to the emergency department if you need more than [specified maximum] inhalations in one day. | Sample instruction: Keep taking usual daily dose(s) | ||
| ICS-LABA maintenance treatment plus SABA reliever as needed | Principle: Increase dose taken on each occasion | Principle: Short-term self-initiated ICS or ICS-LABA increases are not recommended | |
Sample instruction for patient whose usual dose is salbutamol (100 microg/actuation) 1–2 inhalations via pMDI when symptoms occur: Use a spacer. Take 4–6 puffs, one puff at a time. If symptoms do not improve within a few minutes, take 4–6 more puffs. If you need reliever again within 4 hours, contact your doctor same day. | Sample instruction: Keep taking usual daily dose(s). | ||
Additional information
AIR: anti-inflammatory reliever; ICS: inhaled corticosteroids; LABA: long-acting beta2 agonist; MART: maintenance-and-reliever therapy with budesonide-formoterol or beclometasone-formoterol; SABA: short-acting beta2 agonist (salbutamol or terbutaline)
*Table shows only sample adjustments for reliever and maintenance ICS-based treatment when asthma symptoms worsening. Asthma action plans also include other usual treatment such as medicines for comorbid allergic rhinitis, emergency instructions including when to call an ambulance, and instructions according to individual triggers and comorbidity (e.g. when to use adrenaline auto-injector)