NICE also recommends that adults and children 5 years and over should have an asthma self-management programme with a written personalised action plan.7

For adults using ICS in a single inhaler, this can include the option to increase the ICS dose (potentially up to quadruple the dose but not exceeding the maximum daily dose) for seven days when asthma control deteriorates.

The advice for children and adolescents was updated in February 2020. NICE’s 2017 guidance had recommended children’s self-care options could also include quadrupling the dose of ICS for deteriorating asthma. Those with deteriorating symptoms should now be advised to contact a healthcare professional. If the deterioration is due to non-adherence with the ICS, explain that restarting regular use may help them to regain control of their asthma.

The reason given for the February 2020 update is that there is limited evidence for increasing ICS doses to self-manage deteriorating asthma control in young people.