Standard Step 2 therapy

Step 2 therapy is indicated for patients with symptoms or need for reliever therapy twice per month or more. Also consider Step 2 therapy for patients with less frequent symptoms but with risk factors for poor outcomes (see Risk factors for adverse asthma outcomes in adults and adolescents).

Step 2 therapy consists of one of the following:

• regular daily low-dose inhaled corticosteroid (ICS) (plus as-required short-acting beta₂ agonist [SABA])
• as-required low-dose budesonide+formoterol.

Two large randomised controlled trials showed that as-required budesonide+formoterol is as effective as regular daily low-dose ICS therapy for reducing exacerbations in mild asthma, and exposes the patient to a lower total dose of ICS. However, it was less effective than regular daily low-dose ICS at improving asthma symptom control and lung function¹². At the time of writing, other combination products (eg beclometasone+formoterol) are not approved by the Australian Therapeutic Goods Administration (TGA) for use as Step 2 as-required therapy.

For Step 2 therapy with as-required low-dose budesonide+formoterol, use:

For Step 2 therapy with regular daily low-dose ICS with SABA reliever therapy, use: