The BTS/SIGN recommendations for managing asthma in primary care include:8

·      Offer an inhaled short-acting β‚‚ agonist (SABA) as short-term reliever therapy for all patients with symptomatic asthma

·      ICS (usually twice daily) are the recommended initial preventer drug for adults (low dose) and children (very low dose)

·      Before initiating or modifying drug therapy practitioners should recheck adherence and inhaler technique and eliminate trigger factors

·      If there is a need to increase adult therapy consider an inhaled long-acting β‚‚ agonist (LABA) as the first add-on therapy to ICS, before increasing the ICS dose

·      If adults need more symptom control consider increasing the ICS dose to medium or adding a leukotriene receptor antagonist (LTRA). If the LABA seems ineffective consider stopping it. Refer to specialist care if symptoms intensify

·      For children aged 5 and over, consider a LABA or LTRA as initial add-on therapy before increasing the ICS to a low dose. For those under 5, an LTRA could be added. To increase therapy further, refer the child to specialist care

·      Note that a combination ICS/LABA inhaler can aid adherence and mean the LABA is not taken without the ICS

·      Spacers should be considered for adults as well as children.