Principles of prescribing for asthma

Asthma is a chronic respiratory condition associated with airways inflammation and hyper-responsiveness.

The aim of treatment is control of the disease with

No daytime symptoms
No night-time waking due to asthma
No need for rescue medication
No asthma attacks
No limitations on activity including exercise
Minimal side effects from medication
Normal lung function (in practical terms FEV1 and/or PEF>80% predicted or best)⁶

Inhaled therapy is used as the main treatment of asthma, which should be started at the level most appropriate to the initial severity of asthma symptoms. The aim is to achieve and maintain early control by increasing treatment as necessary and reducing unnecessary treatment when control is good.⁶
Personalised asthma action plans, agreed with the healthcare professional, empower individuals to gain control using the minimum dosage of inhaled corticosteroid.⁶
Inhaled corticosteroids are the most effective preventer drug to achieve treatment goals. Add-on therapies, including long-acting beta2 agonists (LABA), leukotriene antagonists, long-acting muscarinic antagonist (LAMA) and theophyllines, should only be initiated after checks to inhaler technique, adherence and elimination of trigger factors.
People with asthma should be reviewed at least annually to determine whether their existing treatment regime is adequately managing their symptoms.⁶ Clinicians should target care and review to optimise therapy and management, considering frequency of review for those most at risk.
Inhaler device selection is important. People with asthma should receive training on how to use their inhaler device and be able to use the device.⁶
The environmental impact of inhalers is a key consideration and prescribers are asked to consider inhalers with a lower global warming potential where appropriate for the individual (see 'Environmental impact of inhalers').

Lung function generally decreases with longer duration of asthma and increasing age, due to stiffness of the chest wall, reduced respiratory muscle function, loss of elastic recoil and airway wall remodelling.²⁶
Factors such as older age may affect inhaler technique. A review was not able to determine whether this was related to dexterity, cognition, physical ability or the device.¹⁷ Inhaler choices should be made with the patient, ensuring the right device for the right patient.⁹
Factors such as arthritis, muscle weakness, impaired vision, and inspiratory flow should be considered when choosing inhaler devices for older adults.²⁶ Individuals with cognitive impairment may require carers to help them use their asthma medications effectively.