📈 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 Will I See This?

• During asthma reviews where control is clearly good or poor

• When prompted by:

  • Exacerbation history

  • SABA overuse

  • Low ACT scores

  • Stable control for ≥3 months

🔁 Step-Up Logic

Use this if asthma is not well controlled:

• Frequent symptoms or night waking

• ≥2 exacerbations or hospital visits in 12 months

• ≥6 SABA inhalers in 6 months

• Low ACT/GINA scores

✅ Consider:

• Adding an ICS if not already on one

• Adding a LABA or LTRA

• Increasing ICS dose

• Referring for specialist input if on high dose already

Document:

• Step-up checkbox

• Rationale (e.g. exacerbation frequency, ACT score)

• Planned review to monitor response

🔽 Step-Down Logic

Use this if asthma is well controlled for ≥3 months:

• No exacerbations

• Low SABA use

• Good ACT score

✅ Consider:

• Reducing ICS dose

• Stopping add-on therapy (LABA/LTRA) cautiously

Key principles:

• Reduce one drug at a time

• Step down to lowest effective dose

• Update the action plan to reflect new PEFR zones if relevant

Document:

• Step-down checkbox

• Reason (e.g. stable for 3+ months)

• Safety-netting advice and follow-up

📋 Documentation Fields

💬 Suggested Prompts for Patients

• “Would you be happy to try a lower dose to see if we can maintain control?”

• “You’ve had quite a few reliever inhalers – shall we look at stepping up your preventer?”

• “Let’s revisit your plan to reflect these changes.”