Other options for Step 4 therapy
Adding a LABA to medium-dose ICS monotherapy is generally more effective than increasing to high-dose ICS monotherapy; however, high-dose ICS monotherapy can be considered as an alternative for individual patients.
Montelukast added to low-dose ICS+LABA therapy (Step 3) can be considered as an alternative to medium-dose ICS+LABA therapy (Step 4), although there is no evidence to support this approach. The recommended montelukast dose is outlined in Other options for Step 2 therapy1. Adults and adolescents who have severe allergic or eosinophilic asthma (identified by elevated total immunoglobulin E) may require monoclonal antibodies.
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