Asthma Maintenance Therapy - Stepwise Approach
Low dose ICS
-> Low dose ICS/LABA or Med/High dose ICS
-> Med dose ICS/LABA
-> High dose ICS/LABA
-> High dose ICS/LABA + tiotropium*
Inhaled Corticosteroids (ICS) is the primary maintenance drug of choice in asthma. Here is a review of the stepwise approach in asthma maintenance. Important to remember that all patients should also receive SABA (i.e. albuterol) PRN. The general approach is to start at a low dose ICS, then add on a LABA, then increase the dose of ICS. If uncontrolled on high dose ICS + LABA, tiotropium (LAMA) can be added. Spiriva Respimat is the only LAMA approved for asthma, and it's important to note that this is NOT the same product used in COPD. The device is the same, but the asthma inhaler is half of the dose of the COPD version (asthma version is blue but COPD version is green). As always, assess appropriate adherence, administration technique, and nonpharmacologic management before increasing medication therapy.
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