Synopsis
Use the current UK ICS/formoterol-first pathway, fix modifiable causes before stepping up, and escalate or step down with explicit review points, device-specific doses and steroid-safety checks.
- Confirm asthma objectively where possible and check inhaler technique, adherence, smoking, triggers and comorbidity before every step up.
- Adults and people aged 12 or over with infrequent symptoms should be offered low-dose ICS/formoterol as-needed anti-inflammatory reliever (AIR), not SABA alone.
- If newly diagnosed and highly symptomatic, or presenting with a severe exacerbation, start low-dose maintenance-and-reliever therapy (MART) rather than AIR alone.
Key red flags
Previous ICU/intubation, recent hospital attendance, repeated oral steroids, poor adherence, excess SABA collection, psychosocial barriers, food allergy or low lung function can confer risk even when daily symptoms seem modest.
Investigation priorities
Measure current impairment and future risk separately.
Management branches
Confirmed asthma in an adult or person aged 12 years or over.
- 1. Infrequent symptoms: offer low-dose ICS/formoterol as needed (AIR), teach device use and give a personalised action plan. Do not add routine SABA to an AIR/MART plan unless a specialist-defined exception applies.
- 2. If AIR does not control asthma, or at diagnosis symptoms are highly symptomatic/recently exacerbating, use low-dose MART: scheduled low-dose ICS/formoterol plus the same inhaler when needed.
Key medicines
Budesonide/formoterol low-dose AIR (example device)Delivered 160/4.5 micrograms per inhalation: 1 inhalation when needed; if symptoms persist after a few minutes take 1 more. Maximum 6 on one occasion; more than 8 in a day is not normally needed and up to 12/day is only for a limited period under the SmPC.
Budesonide/formoterol low-dose MART (example device)Delivered 160/4.5 micrograms: commonly 1 inhalation twice daily (or 2 once daily) plus 1 inhalation as needed; total above 8/day is not normally needed, absolute product maximum 12/day for a limited period.