The Stepwise Management of Asthma
Step 1. Occasional use of inhaled bronchodilators.
Step2. Add low dose inhaled steroids (or other anti-inflammatory agents) (up to 800 micrograms).
Step3. High dose inhaled steroids or low dose inhaled steroids plus long-acting bronchodilators (i.e. salmeterol).
Step 4. High-dose inhaled steroids and regular bronchodilators.
Step 5. Addition of regular oral steroid therapy (40 mg/day).
Note: Occasional temporary step-ups will be needed to control exacerbations. A step down would be considered if symptom control has been good for 3 months or more. Withdrawing anti-inflammatory treatment would only be considered if the patient has been well for at least 6 months.
See the Treatment Plan table below, which summarizes the treatment for asthma for adults and school children.
Treatment Plan for chronic asthma
|
Step 1 |
Step 2 |
Step 3 |
Step 4 |
Step 5 |
|---|---|---|---|---|
|
Asthma with intermittent symptoms. (Mild intermittent asthma). Up to 28% of UK asthma patients. |
Patients needing short acting relievers more than once a day. (Mild persistent or intermittent asthma). Up to 47% of UK asthma patients. |
Patients needing greater therapy to get control, than at Step 2 (Moderate persistent asthma). Up to 11% of UK asthma patients. |
Up to 5% of UK asthma patients. |
Recommended therapy includes treatment as described for Step 4, plus Regular Oral Steroids Less than 5% of patients. |
|
1. Occasional use of short-acting bronchodilators (“relievers”) (beta2 agonists). |
1. Regular inhaled steroids (anti-inflammatory agents). 2. Short-acting relievers as in Step 1. 3. Anti-inflammatory such as a cromone could be used instead of inhaled steroids, but are less effective. |
1) Short-acting beta2agonist (bronchodilators) as required. plus 2) Low-dose inhaled steroid, plus a long-acting inhaled bronchodilator is treatment of choice.(but discontinue long- acting beta2 agonist in the absence of a response). If asthma not controlled: 3) Increase dose of inhaled steroids to upper end of standard dose. If still not controlled, consider: 4) Leukotrine receptor antagonist or Modified release Theophylline or Beta2 agonist modified- release tablet. |
1) Inhaled short- acting beta2 agonist as required with Regular high- dose inhaled corticosteroids plus Inhaled long acting beta2 agonist plus A combination of alternatives such as: Theophylline (modified release) and/or Leukotrine receptor antagonist and/or Beta2 agonist modified release tablet. Inhaled anticholinergics Cromones. |
Inhaled short- acting beta2 agonist as required with Regular high- dose inhaled corticosteroid and One or more long- acting bronchodilators (see step 4) plus Regular Prednisolone tablets (as single daily dose). Regular review Every 3 to six months is recommended and if control is achieved, a regular step-wise reduction in treatment should be tried. |
- NHS Choices
Amended April 2011
