Asthma: Pharmacological management for adults ≥18 years

Respiratory Service:-

Respiratory Consultants, Specialty Doctors, Specialist Nurses, Senior Pharmacists, Management.

Localised guidelines due to the national guidance change in November 2024:

Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) Reference number: NG245. Published: 27 November 2024.

ADTC 105/08. Asthma: Pharmacological Management Guideline for adults 18 years (only available on Athena intranet)

Supersedes ADTC 105/07.

General principles:

Consider alternative diagnoses or co-morbidities, active or passive smoking (including e-cigarettes), psychosocial factors, seasonal factors, environmental factors, obesity.

Do not prescribe a SABA to people of any age diagnosed with asthma without a concomitant prescription of an inhaled corticosteroid.

Start treatment at the level most appropriate to initial severity (Symptom relief [AIR]/MART/Maintenance Therapy) then achieve early control and maintain control by increasing treatment as necessary, choosing carbon friendly options where possible such as DPIs or SMIs.

Uncontrolled asthma is defined as any exacerbation requiring oral corticosteroids or frequent regular symptoms (such as using reliever inhaler 3 or more days a week or at night)

If current formulary choices are unsuitable, or are not tolerated, please refer to the West of Scotland Respiratory Formulary for any additional choices.

Review control 8-12 weeks after commencing treatment or making any changes in order to assess response.

All people with asthma (and/or their parents or carers) should be offered self-management education which should include a written personalised asthma action plan and be supported by regular professional review.

Please prescribe all inhalers by brand name (exception Salbutamol MDI,if prescription still appropriate).

An assessment of inhaler technique should be routinely undertaken and formally documented at annual review and checked by a pharmacist when a new inhaler is dispensed.

Always check adherence, inhaler technique and elimination of trigger factors before stepping up treatment.

Decrease treatment when control is good. Consider stepping down treatment when asthma has been well controlled for more than 3 months.

Asthma and Lung UK. AIR Asthma Action Plan 

Asthma and Lung UK. MART Asthma Action Plan 

Bibliography:

1.BMJ Group and Royal Pharmaceutical Society of Great Britain. Medicines Complete BNF. Available online at: https://www.medicinescomplete.com/mc/bnf/current/ Accessed 08/01/2026

2.British Guideline on the Management of Asthma (SIGN 158) Amended May 2025. Available online at British guideline on the management of asthma Accessed 08/01/2026

3.NHS Ayrshire and Arran. Joint Formulary Abbreviated List September 2025 Available on Athena at NHSAAAbbreviatedformulary.pdf Accessed 08/01/2026

4.Ricardo-AEA on behalf of Scottish Government. Air Quality in Scotland http://www.scottishairquality.co.uk/ Accessed 08/01/2026

5.Diagnosis of Diseases of Chronic Airflow Limitation: Asthma, COPD and Asthma –COPD Overlap syndrome, 2014. Available online at GINA_GOLD_ACOS_2014-wms.pdf. Accessed 08/01/2026

6.Scottish Government. Seasonal Influenza (flu) Immunisation Programme 2024/25 in Scotland. Available online at Seasonal influenza (flu) immunisation programme 2024-25: confirmation of adult and child cohorts