Assessing patient response to Step 3 therapy

Assess symptom control 4 to 8 weeks after starting Step 3 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 3 therapy, continue treatment and review again after 3 months. Therapy may be able to be stepped down if control remains good.

Note: Every asthma assessment should include a review of treatment adherence and inhaler technique.

If the patient has partial or poor control on Step 3 therapy, review adherence and inhaler technique, and check equipment (drug device, spacer) for breakage or blockage. Before escalating to Step 4 therapy, also assess for comorbidities (eg rhinitis), and ensure exposure to triggers is minimised.

If the patient is using a therapy other than ICS+LABA (eg montelukast, ICS monotherapy) and has partial or poor control, switch therapy to ICS+LABA rather than escalating to Step 4 therapy, if possible.

If the patient has shown minimal response to treatment consider an alternative diagnosis, see clinical diagnosis of asthma.