5th January 2024

Management of chronic asthma in adults (Aged 17 years or above)

Principles of Pharmacological Management

• Consider alternative diagnosis or possible reasons for uncontrolled asthma before adjusting treatment.
• Review response to treatment 4-8 weeks after starting or adjusting medicines.
• Offer regular daily inhaled corticosteroids ( ICS) instead of intermittent ICS.
• Aim for the lowest required dose of ICS for effective asthma control.
•  Offer a self-management plan consisting of a written personalised action plan and education.
• Consider the possible reasons for uncontrolled asthma before adjusting medications, such as lack of adherence, occupational exposures, psychological factors, alternative diagnosis, and smoking.
• Ensure proper technique of inhaler devices.

Pharmacological treatment pathway for adults (age 17 and above)

Pharmacological management of adults (17 years and over) with newly diagnosed asthma or uncontrolled asthma on their current treatment in a stepwise fashion:

• Short-acting Beta2 agonist (SABA) as reliever therapy alone for people with infrequent and brief periods of wheeze and normal lung function.
• Low-dose ICS as maintenance therapy for people with:
  • Uncontrolled asthma with SABA alone.
  • Symptoms at presentation indicating need for maintenance therapy such as: nocturnal symptoms or symptoms three times a week.
• Leukotriene receptor antagonist (LTRA) in addition to the above.
• Long-acting beta2 agonist ( LABA) in addition to low dose ICS and review response to LTRA.
• Change low-dose ICS and LABA to MART (Maintenance and reliever therapy combines ICS and fast-acting LABA and is used as both maintenance and reliever therapy).
• Increase ICS dose from low to moderate maintenance dose as a MART regimen or moderate dose ICS + LABA + SABA.
• Increase ICS to high dose (as part of fixed regimen);
• or trial of long-acting muscarinic antagonist or theophylline SIGN 158.

Decreasing maintenance therapy

Consider decreasing therapy when asthma symptoms are controlled with current treatments for at least 3 months.