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.
- If AIR is insufficient, move to low-dose MART; if low-dose MART remains insufficient after correction of basics, trial moderate-dose MART for 8-12 weeks.
- If uncontrolled on moderate-dose MART, refer to an asthma specialist rather than repeatedly adding unsupervised medicines or oral steroid courses.
- AIR and MART require a fast-acting formoterol combination; not every ICS/LABA inhaler can be used as a reliever.
- Prescribe by brand/device and state maintenance, as-needed and maximum doses because nominal and delivered strengths differ.
- Every patient needs a personalised action plan covering daily treatment, deterioration thresholds, attack instructions and urgent help.
- Review 8-12 weeks after starting or changing treatment; consider step-down after sustained control, usually reducing ICS exposure gradually with close review.
- Track SABA and oral corticosteroid exposure even in people using AIR/MART; repeated rescue use or steroid courses signal excess risk and require reassessment.