Respiratory: Asthma

Question 1

First line management asthma

Answer 1

SABA

Question 2

When to step up asthma treatment to second line?

Answer 2

Not controlled on previous step
OR
Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking

Question 3

Second line management asthma?

Answer 3

SABA + low-dose inhaled corticosteroid (ICS)

Question 4

Third line management asthma?

Answer 4

SABA + low-dose ICS + leukotriene receptor antagonist (LTRA)

Question 5

Fourth line management asthma?

Answer 5

SABA + low-dose ICS + long-acting beta agonist (LABA)

Continue LTRA depending on patient’s response to LTRA

Question 6

Fifth line management asthma?

Answer 6

SABA +/- LTRA

Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS

Question 7

Sixth line management asthma?

Answer 7

SABA +/- LTRA + medium-dose ICS MART

OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA

Question 8

Seventh line management asthma?

Answer 8

SABA +/- LTRA + one of the following options:
- increase ICS to high-dose (only as part of a fixed-dose regime, not as a MART)
- a trial of an additional drug (for example, a long-acting muscarinic receptor antagonist or theophylline)
- seeking advice from a healthcare professional with expertise in asthma

Question 9

What is in a MART?

Answer 9

combined ICS and LABA in single inhaler

used for both daily maintenance therapy and the relief of symptoms as required