Asthma current guidelines

Initial assessment and diagnosis: Asthma diagnosis requires a suggestive clinical history (wheeze, cough, breathlessness, chest tightness, symptom variability) supported by objective tests; diagnosis should not be confirmed without both ². Physical examination may identify wheeze but a normal exam does not exclude asthma ².

Initial treatment: For people aged 12 and over with newly diagnosed asthma, offer a low-dose inhaled corticosteroid (ICS)/formoterol combination inhaler as needed for symptom relief (anti-inflammatory reliever [AIR] therapy) ¹. If symptoms are frequent or severe, offer low-dose maintenance and reliever therapy (MART) with ICS/formoterol ¹. For children under 5, start with low-dose ICS for 8–12 weeks as empirical treatment, with specialist referral if diagnosis is uncertain or asthma is uncontrolled ¹.

Self-management and education: Provide advice on self-care, avoidance of triggers, smoking cessation, weight management, regular physical activity, stress management, and ensure vaccinations are up to date ¹. A personalised asthma action plan should be provided and reviewed regularly ¹,².

Monitoring: Review asthma control at least annually and after exacerbations, using symptom questionnaires and clinical assessment; routine peak expiratory flow monitoring is not recommended unless personalised ². Fractional exhaled nitric oxide (FeNO) monitoring may be considered in adults ².

Stepping up and down treatment: Step up treatment if control is suboptimal, considering MART or adding leukotriene receptor antagonists (LTRA) in children if MART is not suitable ¹,². Step down treatment after 8–12 weeks of good control, maintaining the minimum effective ICS dose, with instructions on how to restart if symptoms worsen ¹.

Specialist referral: Refer to asthma specialists if diagnosis is uncertain, asthma is uncontrolled despite treatment, or occupational asthma is suspected ².

Pregnancy: Continue ICS-containing treatment during pregnancy to reduce risk of exacerbations and adverse perinatal outcomes ¹.