Other options for Step 3 therapy

Adding a LABA to low-dose ICS monotherapy (as above) is generally more effective than increasing to medium-dose ICS monotherapy; however, medium-dose ICS monotherapy can be considered as an alternative for individual patients. See Inhaled corticosteroid–based inhalers available in Australia for asthma in adults and adolescents for dosage, formulation and device details of medium-dose ICS-based inhalers available in Australia for asthma.

Montelukast added to regular daily low-dose ICS therapy (Step 2) can be considered as an alternative to low-dose ICS+LABA therapy (Step 3), but is less effective. It may be useful in patients with coexisting allergic rhinitis. The recommended montelukast dose is outlined in Other options for Step 2 therapy ¹.

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