Asthma Management Handbook
Close window

Table. Options for adjusting medicines in a written asthma action plan for adults

Usual treatment

Options for adjustments when asthma worsening

Option 1

Option 2 *

Any treatment (applies to all regimens)

Increase reliever as needed in response to symptoms

N/A

Short-acting beta2-agonist reliever only (no preventer)

If symptoms continue to worsen, start short course prednisolone (e.g. 37.5–50 mg each morning for 5–10 days)

Start regular ICS-containing preventer treatment, and continue for at least 2–4 weeks

Ensure patient knows how to use the inhaler correctly

ICS-only preventer

Increase dose early (e.g. multiply dose by 4) for 7–14 days §

Start short course prednisolone (e.g. 37.5–50 mg each morning for 5–10 days) in addition to usual dose of ICS

ICS/LABA combination

Budesonide/formoterol (Symbicort) maintenance-and-reliever regimen

Take extra doses of budesonide/formoterol as needed to relieve symptoms, up to a maximum of 72 microg formoterol per day (12 actuations of 100/6 microg or 200/6 microg via dry-powder inhaler or 24 actuations of 50/3 microg or 100/3 microg via pressurised metered-dose inhaler per day)

No more than 6 actuations at one time

Start short course prednisolone (e.g. 37.5–50 mg each morning for 5–10 days) in addition to usual budesonide/formoterol regimen

Budesonide/formoterol (Symbicort) conventional maintenance regimen

Increase dose of budesonide/formoterol up to a maximum of 72 microg formoterol daily for 7–14 days

Start short course prednisolone (e.g. 37.5–50 mg each morning for 5–10 days) in addition to usual dose of budesonide/formoterol

Fluticasone furoate/vilanterol (Breo)

If using medium dose (100/25 microg): Replace with highest strength formulation of same medicine (fluticasone furoate/vilanterol 200/25 microg one inhalation once daily) for 7–14 days

Start short course prednisolone (e.g. 37.5–50 mg each morning for 5–10 days) in addition to usual dose of fluticasone furoate/vilanterol

Fluticasone propionate/formoterol (Flutiform)

If using 50/5 microg: Replace with highest strength formulation of same medicine (fluticasone propionate/formoterol 250/10 microg) for 7–14 days

If using 125/5 microg: Increase dose (e.g. multiply dose by 2) to achieve equivalent of highest strength formulation of same medicine (fluticasone propionate/formoterol 250/10 microg) for 7–14 days

If using 250/10 microg: Increase ICS dose (e.g. multiply ICS dose by 4) by adding a separate fluticasone propionate inhaler for 7–14 days §

Start short course prednisolone (e.g. 37.5–50 mg each morning for 5–10 days) in addition to usual dose of fluticasone propionate/formoterol

Fluticasone propionate/salmeterol (Seretide, Fluticasone and Salmeterol Cipla)

Increase ICS dose (e.g. multiply ICS dose by 4) by adding a separate fluticasone propionate inhaler for 7–14 days §

Increase fluticasone propionate/salmeterol if necessary to achieve total daily dose of salmeterol 100 microg
Start short course prednisolone (e.g. 37.5–50 mg each morning for 5–10 days) in addition to usual dose of fluticasone propionate/salmeterol

* Second-line options for clinicians to consider when writing instructions for patients. The individual’s written asthma action plan should contain only one clear action for each situation.

†  Increase only the fluticasone propionate dose (e.g. by prescribing a separate fluticasone propionate inhaler for 7–14 days in addition to the combination inhaler). The salmeterol dose should not be increased above 100 microg/day.

§ This option may be preferred over oral corticosteroids for patients who experience significant mood effects or other significant side-effects (e.g. hyperglycaemia) with oral corticosteroids. It is unsuitable for patients who cannot tolerate increased risk of dysphonia (e.g. singers, actors, teachers) or who cannot afford an additional inhaler. For fluticasone furoate (Arnuity), the dose increase should take into account the fact that available formulations are medium and high doses, and that the inhaler must be discarded one month after opening.

Notes

The table provides options for adjustments the patient can make when asthma is getting worse (needing more reliever than usual, waking up with asthma, more symptoms than usual, asthma is interfering with usual activities, or when the use of reliever is not achieving rapid relief from symptoms). After choosing the most suitable strategies for the individual, the clinician should translate these into clear, easy-to-follow instructions in the person’s written asthma action plan.

For some preventer formulations, the suggested option may result in doses above those recommended in TGA-approved product information. If high doses are needed, they should be continued for only 7–14 days then reduced.

Templates for written asthma action plans (including templates designed for people using various preventer regimens) are available from the National Asthma Council Australia.

Sources

Canadian Thoracic Society. Canadian respiratory guidelines. Recommendations for the diagnosis and management of asthma. Preschoolers, children and adults 2012 update ('Slim Jim' brochure). Ottawa: Canadian Thoracic Society; 2012. Available from: http://www.respiratoryguidelines.ca/toolkit

Reddel H, Barnes D. Pharmacological strategies for self-management of asthma exacerbations. Eur Respir J 2006; 28: 182–99. Available from: http://erj.ersjournals.com/content/28/1/182.long

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2014. GINA; 2014. Available from: http://www.ginasthma.org/

Note: PBS status as at March 2019: Fluticasone furoate is not subsidised by the PBS, except in combination with vilanterol.

Last reviewed version 2.0

Back to top

Asset ID: 42