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.
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
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
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
Field | Purpose |
| Step-Up Applied | Confirms escalation based on clinical criteria |
| Step-Down Applied | Confirms de-escalation due to good control |
| Reason Documented | Ensures decision is auditable and patient-specific |
| Follow-Up Planned | Confirms timing of review to reassess impact |
“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.”