Chronic management — escalate based on symptom control.
Regimens
Step 1
SABA PRN (salbutamol 100 mcg 2 puffs)
Step 2
Add low-dose ICS (beclomethasone 200 mcg BD)
Step 3
Add LTRA (montelukast 10 mg nocte) or LABA
Step 4
MART regimen — combined ICS/formoterol used as both reliever and preventer
Acute severe
O₂, salbutamol 5 mg neb back-to-back + ipratropium 0.5 mg neb, prednisolone 40 mg PO × 5 d, IV magnesium 2 g if poor response
Monitoring
- • Peak flow diary
- • Inhaler technique annually
- • Symptoms (RCP3) + exacerbations
Common prescribing errors
- ⚠ LABA without ICS (mortality)
- ⚠ SABA monotherapy >3 inhalers/year (poor control marker)
- ⚠ Discharge without PEF / steroid course / follow-up
