Assessing patient response to Step 5 therapy

Assess symptom control 4 to 8 weeks after starting Step 5 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, continue treatment and review again after 3 months. Attempt to step down therapy if control remains good. Few patients should require long-term Step 5 therapy.

If the patient has partial or poor control on Step 5 therapy, review adherence and inhaler technique, and check equipment (drug device, spacer) for breakage or blockage. Also assess for comorbidities (eg rhinitis) that could be reducing asthma control, and ensure exposure to triggers is minimised.

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

Refer all patients requiring Step 5 therapy to a respiratory physician, particularly if the patient has shown minimal response to treatment, or if the diagnosis is in doubt. See Severe asthma in adults and adolescents: specialist management for information about specialist treatments.