Assessing patient response to Step 2 therapy

Assess symptom control 4 to 8 weeks after starting Step 2 therapy. See Assessment of asthma control in adults and adolescents for classification of good, partial and poor control.

If the patient’s symptoms are well controlled with Step 2 therapy, continue treatment and review again after 3 months.

If the patient has partial or poor control on Step 2 therapy, review adherence and inhaler technique, and check equipment (drug device, spacer) for breakage or blockage. Before escalating to Step 3 therapy, also assess for comorbidities (eg rhinitis) that could reduce asthma control, and ensure exposure to triggers is minimised. Most patients with asthma can achieve good control with Step 2 therapy.

If the patient is taking montelukast and has partial or poor control, switch therapy to regular daily low-dose ICS or as-required low-dose budesonide+formoterol, if possible, rather than escalating to Step 3 therapy.