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Asthma - Management
Overview of management

Acute exacerbation of asthma

Chronic asthma

  • The aim of treatment of chronic asthma is to achieve early control, maintain control and to prevent exacerbations.
  • All people with a new presentation of suspected asthma need an assessment. The aim is to assess the pattern of asthma symptoms, detect possible trigger factors, and determine the impact of asthma on activities of daily living and psychological wellbeing.
  • Manage uncontrolled asthma using a step-wise approach based on the person's age and asthma severity:
    • Step 1: Treat with a short-acting beta2-agonist.
    • Step 2: Regular preventative therapy: prevent asthma using inhaled corticosteroids (ICS).
    • Step 3: Add-on therapy: this consists of several treatment options, such as a trial of long-acting beta2-agonists, increasing the dose of ICS, or adding one of a leukotriene receptor antagonist (especially in children under 5 years of age), theophylline, or an oral beta2–agonist (adults only). Consider referral for children under 2 years of age.
    • Step 4: Persistent poor control: increase to maximum dose of ICS and consider a trial of two add-on drugs. Refer all children under 5 years of age.
    • Step 5: Regular oral corticosteroids: add oral corticosteroids to existing treatment only after specialist advice if symptoms are not controlled.
    • Before starting a new drug, check that trigger factors have been eliminated as far as possible, check inhaler technique, and assess concordance with medication.
  • Step-down treatment when symptoms are controlled.
  • In addition to drug treatment, offer self-management education, including written asthma action plans; tailor these plans to the needs and preferences of the individual.
  • Provide advice about stopping smoking, vaccinations, comorbidities, allergen avoidance and weight reduction, diet, and exercise.
  • People who have exercise-induced asthma or occupational asthma, or women who are pregnant may require specific management.

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