Asthma in Adults and Adolescents (Age 12 and Older): What to Do When Step 1–2 Treatment Has Not Achieved Control
For patients aged 12 and older, asthma management follows a stepwise approach. When the initial treatment step does not achieve the goal of well-controlled asthma, a more intensive strategy becomes the appropriate next step.
Previous Treatment — Control Not Achieved
Step 1–2 therapy — as-needed low-dose ICS-formoterol taken only when symptoms occur, or a regular low-dose inhaled corticosteroid with a short-acting reliever as needed — did not reach the target of well-controlled asthma, defined as:
- No troublesome asthma symptoms during the day or at night
- No severe asthma exacerbations
- Normal or near-normal lung function
- Ability to lead an active life
Next-Step Approach
The next step introduces a strategy in which an ICS-formoterol combination is taken as regular daily maintenance treatment, with additional doses of the same medication used as the reliever when symptoms arise. The complete options, dosing, and clinical algorithm are available in the structured protocol.
Treatment Goal
- No troublesome asthma symptoms during the day or at night
- No severe asthma exacerbations
- Normal or near-normal lung function
- Ability to lead an active life, including exercise
References
- There are different treatment recommendations for adults/adolescents (page 23) and children aged 6–11 years (page 29).
- In Steps 3–5, patients take combination ICS-formoterol as daily maintenance treatment, and they take extra doses of the same medication when they have asthma symptoms.
- This is called “maintenance-and-reliever therapy” (MART) with ICS-formoterol.
- ‘Well-controlled asthma’ means that the person does not have severe asthma exacerbations, they do not have troublesome asthma symptoms during the day or night, they have normal lung function or almost normal lung function, and they are able to lead active lives, including exercise.
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