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● You should consider therapy escalation If asthma is no longer controlled and the patient's medication technique, therapy adherence, and avoidance of risk factors have been verified.
● Consider escalation in partly-controlled but implement it immediately in uncontrolled patients. Escalate stepwise until asthma control has been reinstated. Escalating measures depends on the patient's current Therapy Step. Typical examples are doubling of inhaled glucocorticosteroids and deployment of long-acting B2 agonists (never without inhaled glucocorticoids!), of oral glucocorticoids, or of omalizumab (in severe allergic asthma).
● Assess the escalation effect every 4 weeks. Escalate further if no control has been achieved. Maintain the Therapy Step at which asthma control has been achieved for several months, then attempt de-escalation.
● Note that limited therapy escalation can be implemented autonomously by the patient, based on self-assessment and a pre-agreed action plan.
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