Managing Maintenance Therapy

Managing Maintenance Therapy

🔄 Managing Maintenance Therapy

This shared component provides a structured way to record decisions around stepping up or stepping down asthma maintenance therapy, based on the patient's symptom control and clinical course.

🧭 When Will I See This?

  • During an asthma review 

📋 What To Record



Field
Purpose
Step-Up ImplementedTick if stepping up therapy due to poor control, with supporting notes
Step-Down ConsideredTick if stepping down therapy due to sustained good control
Details of ChangeOptional free-text to record specific treatment adjustments and rationale

📘 Make sure to also update the Self-Management Plan and arrange follow-up if medication is changed

🧠 Step-Down Guidance

  • Only consider if asthma well-controlled for at least 3 months

  • Gradual reduction in inhaled corticosteroid (ICS) dose or simplification of regimen

  • Monitor carefully and review action plan thresholds

⚠️ Step-Up Guidance

  • Consider if patient has had:

    • ≥2 exacerbations in past 12 months

    • Poor ACT score or frequent reliever use

    • Poor adherence or incorrect inhaler technique already addressed

  • Increase ICS dose or add-on therapy (LABA, LTRA)

💬 Suggested Questions to Ask

  • “Have you been using your reliever inhaler more often recently?”

  • “Do you feel your symptoms have been well controlled?”

  • “Would you be open to adjusting your preventer medication to match how things are going?”

    • Related Articles

    • Step-Up / Step-Down Therapy Logic

      ? Step-Up / Step-Down Therapy Logic This shared component helps clinicians adjust asthma maintenance therapy based on symptom control. It supports proactive treatment changes and ensures decisions are well-documented, safe, and QOF-aligned. ? When ...

    • Adherence to Inhaled Therapy

      ? Adherence to Inhaled Therapy Adherence to asthma medication is critical to achieving good symptom control and preventing exacerbations. This shared component supports structured conversations to identify non-adherence and plan support. ? When ...

    • Managing Patient Queries and Concerns about Recalls

      Introduction The Primary Care IT lesson on implementation of OneRecall contains more detailed stepped instructions Patients may have questions or concerns about their recalls, including why they are being recalled, how to book an appointment, and ...

    • Managing Non-Responders and Follow-Up Recalls

      Introduction The Primary Care IT lesson on implementation of OneRecall contains more detailed stepped instructions Not all patients respond to initial recall invitations. Effective management of non-responders ensures that patients receive necessary ...

    • Summary of PCSE and Practice responsibilities for managing smears

      PCSE Practice Call and recall Ensure all women are included in the programme Check with the GP Practice to ensure invitation is appropriate (Prior Notification Lists/e-PNL) Send a disclaimer letter to women who wish to opt out of screening and are ...