Other options for Step 2 therapy

An alternative option for Step 2 therapy is to take a low dose of an ICS (using the doses above) whenever a dose of SABA is required, following a similar principle to using as-required low-dose budesonide+formoterol.

Montelukast can be considered instead of an ICS-based treatment, although it is less effective than regular daily low-dose ICS for controlling asthma symptoms and reducing exacerbation risk. It can be trialled in patients who have experienced adverse effects with ICS, or who remain unwilling to use steroid-based therapy after an informed discussion with their clinician. It may also be useful in patients with coexisting allergic rhinitis, or in whom inhaled therapy is not practical. Use:

montelukast 10 mg orally, once daily1. asthma, Step 2 therapy (adult, adolescent) montelukast montelukast montelukast

1 Neuropsychiatric adverse effects (eg behavioural changes, depression, suicidality) have been reported in all age groups taking montelukast. Adverse effects are generally mild and may be coincidental; however, symptoms may be serious and continue if treatment is not stopped. Advise patients, parents and carers to be alert for changes in behaviour and new psychiatric symptoms. Stop treatment if these effects occur. In some cases, symptoms may persist after stopping treatment; patients should be monitored and provided supportive care until symptoms resolve. See the Australian Therapeutic Goods Administration (TGA) safety alert for more information.Return