Asthma in Adolescents and Adults (Age 12+): When Low-Dose ICS-Formoterol MART Is Not Achieving Control

This protocol addresses patients aged 12 years or older with asthma whose symptoms and lung function have not reached adequate control on Step 3 low-dose maintenance-and-reliever therapy. It defines the structured escalation for this age group.

Clinical Scenario

Patient population: adolescents and adults aged 12 years or older with asthma. Treatment recommendations for this age group differ from those for children aged 6–11 years and are addressed separately.

Previous Treatment — Goals Not Met

The prior step involved Step 3 low-dose maintenance-and-reliever therapy (MART) with ICS-formoterol. That step aimed for well-controlled asthma: no troublesome symptoms during the day or night, no severe exacerbations, normal or near-normal lung function, and the ability to lead an active life. When those goals are not achieved, this protocol provides the next structured escalation.

Next Step: Partial Overview

This protocol escalates to a medium-dose maintenance-and-reliever approach using ICS-formoterol combination therapy. Both a preferred track and an alternative track exist. The complete algorithm, full management details, and any additional options remain available in the full protocol.

The clinical goal remains well-controlled asthma: no troublesome day or night symptoms, no severe exacerbations, preserved lung function, and an active life including exercise.

Instant Access to Structured Evidence-Based Regimens

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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