Common treatment ladders

Question 1

Asthma - adult management

Answer 1

Step 1
a low-dose inhaled corticosteroid (ICS)/formoterol combination. (AIR) therapy. As required

if very symptomatic - start treatment with low-dose MART (maintenance and reliever therapy, see below)
treat the acute symptoms as appropriate (e.g. a course of oral corticosteroids may be indicated)

Step 2
a low-dose MART
MART describes using an inhaled corticosteroid (ICS)/formoterol regularly AND as required

Step 3
a moderate-dose MART

Step 4
(FeNO) level if available, and the blood eosinophil count
if either of these is raised, refer to a specialist in asthma care

if neither raised, trial of either a leukotriene receptor antagonist (LTRA) or a long-acting muscarinic receptor antagonist (LAMA) used in addition to moderate-dose MART
if control has not improved, stop the LTRA or LAMA and start a trial of the alternative medicine (LTRA or LAMA)

Step 5
refer people to a specialist in asthma care when asthma is not controlled despite treatment with moderate-dose MART, and trials of an LTRA and a LAMA

Question 2

COPD stable management

Answer 2

1) SABA or SAMA as required
2) SABA/SAMA plus ICS (if asthmatic features etc.) or SABA plus LABA plus LAMA
3) SABA plus LABA plus LAMA plus ICS

Question 3

Genital wart treatment:

Answer 3

If single, solitary lesion -> cryotherapy
If multiple -> topical PODOPHYLLUM