Managing Adult Asthma in Steps
When doctors decide how best to treat your asthma, they use a 'stepwise' approach.
Each step shows what treatment is needed to control your asthma. If the treatment on one step is not working, your doctor may recommend moving up to the next step. More importantly, if your asthma is well controlled your doctor may recommend moving down a step.
Step 1
Using your reliever twice or less per week. If you are using it more than twice a week you should go to step 2.
Step 2
In addition to your reliever, you will now need to take regular preventer/controller treatment to reduce the inflammation in your airways. This will almost always be a low-dose steroid inhaler and/or LRA (leukotriene receptor antagonist).
Step 3
If your asthma is not fully controlled, before increasing preventer/controller treatment, your doctor should offer you a trial of 'add-on therapy', such as a long-acting reliever. Symptoms should then be assessed to see if there has been an improvement. There are other 'add-on' treatments available and if the long-acting reliever medicine has no effect, your doctor should stop this treatment before introducing other medicines. Patients who are not controlled on Step 3 medications should be referred to a respiratory specialist for further investigation.
Step 4
Selection of treatment at Step 4 depends on the response to prior treatments at Step 2 and Step 3. Increase in preventer/controller medication, in addition to further add-on therapies, may be introduced to gain control at this stage.
Step 5
Your symptoms are still difficult to control, even on maximum amounts of medicine. Your respiratory specialist may investigate your condition further and also assess to see if you are suitable for lgE treatment.
Stepping up and stepping down
You should be on the lowest dose of medicine to control your asthma. Once your asthma is under control, your doctor may consider 'stepping down' your medicines to see if your symptoms will stay controlled on a lower dose. It is important that your doctor or nurse reviews your symptoms after your medicines have been 'stepped down' to see what effect it has had.
Your asthma should be stable and well controlled for at least 3 months before your doctor will consider reducing your medication.
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