Standard Step 3 therapy

Step 3 therapy is indicated for patients who remain uncontrolled on optimised Step 2 therapy. Step 3 therapy could also be considered as initial therapy for patients with troublesome asthma symptoms occurring on most days, or with frequent waking due to asthma (particularly if the patient has risk factors for adverse asthma outcomes).

Step 3 therapy consists of regular daily low-dose inhaled corticosteroid plus long-acting beta2 agonist (ICS+LABA) therapy, plus an as-required reliever.

Always give ICS+LABA therapy as a combination inhaler to avoid the possibility of a patient taking a LABA without an ICS—LABA monotherapy increases the risk of exacerbations and asthma-related death. Using separate inhalers risks the patient stopping the ICS because of a perceived lack of benefit compared with the LABA (which provides quick relief of symptoms).

Note: Always give ICS+LABA as a combination inhaler—LABA monotherapy increases the risk of exacerbations and asthma-related death.

Patients taking ICS+formoterol maintenance therapy with either budesonide+formoterol or beclometasone+formoterol can use the same inhaler for reliever therapy (ICS+formoterol ‘maintenance and reliever therapy’). ICS+formoterol maintenance and reliever therapy is associated with a lower risk of exacerbations than ICS+LABA maintenance plus SABA reliever therapy.

For Step 3 therapy with low-dose ICS+formoterol maintenance and reliever therapy, use:

1 beclometasone+formoterol 100+6 micrograms by inhalation via pMDI with spacer, twice daily12 asthma, Step 3 maintenance and reliever therapy (adult, adolescent) beclometasone + formoterol beclometasone+formoterol beclometasone+formoterol

PLUS

beclometasone+formoterol 100+6 micrograms by inhalation via pMDI with spacer, as required, up to a maximum total daily dose (including maintenance doses) of 800+48 micrograms daily (see Table 9.3 for regimen expressed as number of inhalations)12 beclometasone + formoterol beclometasone+formoterol beclometasone+formoterol

OR

1 budesonide+formoterol 100+6 or 200+6 micrograms by inhalation via pMDI with spacer or via DPI3, twice daily asthma, Step 3 maintenance and reliever therapy (adult, adolescent) budesonide + formoterol budesonide+formoterol budesonide+formoterol

PLUS

budesonide+formoterol 100+6 or 200+6 micrograms by inhalation via pMDI with spacer or via DPI4, as required, up to a maximum total daily dose (including maintenance doses) of 2400+72 micrograms daily (see Table 9.3 for regimen expressed as number of inhalations). budesonide + formoterol budesonide+formoterol budesonide+formoterol

For Step 3 therapy with regular daily low-dose ICS+LABA combination with SABA reliever therapy, use:

a SABA as required (see Step 1 for dosage)

PLUS ONE OF THE FOLLOWING

1 beclometasone+formoterol 100+6 micrograms by inhalation via pMDI with spacer, twice daily (see Table 9.3 for regimen expressed as number of inhalations)2 asthma, Step 3 maintenance therapy (adult, adolescent) beclometasone + formoterol beclometasone+formoterol beclometasone+formoterol

OR

1 budesonide+formoterol 100+6 or 200+6 micrograms by inhalation via pMDI with spacer or via DPI, twice daily (see Table 9.3 for regimen expressed as number of inhalations) asthma, Step 3 maintenance therapy (adult, adolescent) budesonide + formoterol budesonide+formoterol budesonide+formoterol

OR

1 fluticasone propionate+formoterol 100+10 micrograms by inhalation via pMDI with spacer, twice daily (see Table 9.3 for regimen expressed as number of inhalations) asthma, Step 3 therapy (adult, adolescent) fluticasone propionate + formoterol fluticasone propionate+formoterol fluticasone propionate+formoterol

OR

1 fluticasone propionate+salmeterol 100+50 micrograms by inhalation via pMDI with spacer or via DPI, twice daily (see Table 9.3 for regimen expressed as number of inhalations). asthma, Step 3 therapy (adult, adolescent) fluticasone propionate + salmeterol fluticasone propionate+salmeterol fluticasone propionate+salmeterol

OR

1mometasone+indacaterol 62.5+125 micrograms by inhalation via DPI, once daily (see Table 9.3 for regimen expressed as number of inhalations).mometasone + indacaterolmometasone+indacaterolmometasone+indacaterol

1 At the time of writing, beclometasone+formoterol is not available on the Pharmaceutical Benefits Scheme (PBS) as maintenance and reliever therapy. See the PBS website for current information.Return
2 Beclometasone+formoterol is not approved by the Australian Therapeutic Goods Administration (TGA) for use in patients under 18 years.Return
3 At the time of writing, only the budesonide+formoterol 50+3 and 100+3 micrograms formulations of pMDI (not the 200+6 micrograms formulation) are approved by the Australian Therapeutic Goods Administration (TGA) for use as ICS+formoterol maintenance and reliever therapy. The 100+6 and 200+6 micrograms formulations of DPI are both approved by the TGA for this indication.Return
4 At the time of writing, only the budesonide+formoterol 50+3 and 100+3 micrograms formulations of pMDI (not the 200+6 micrograms formulation) are approved by the Australian Therapeutic Goods Administration (TGA) for use as ICS+formoterol maintenance and reliever therapy. The 100+6 and 200+6 micrograms formulations of DPI are both approved by the TGA for this indication.Return