The majority of patients with a new diagnosis of asthma should be started on an inhaled corticosteroid. On follow up, it is important to titrate their medication to achieve optimal control of their symptoms. This may be a ‘step up’ or a ‘step down’, according to the Asthma Pharmacotherapy tool in the BTS/SIGN Asthma guidelines (below).

Patients should be on the lowest step that provides complete asthma control, so it might take some time to ‘step up’ AND ‘step down’ therapy before you achieve optimal control.