How is asthma treated?

The good news for anyone with asthma in the UK is that there is a range of effective treatments

If you have been diagnosed with severe asthma, please visit our severe asthma section, which has lots of advice and information especially for you.

When you're first diagnosed with asthma, your GP or asthma nurse will prescribe you treatment based on the latest gold standard guidelines for asthma care. These are from recommendations in the latest British Thoracic Society/Scottish Intercollegiate Guidelines Network on the management of asthma (BTS/SIGN). They are based on the latest clinical evidence and updated every two years. They state that the aim of treatment is to manage your asthma so that:

  • you get no daytime symptoms
  • you get no night-time waking due to asthma
  • you have no need for rescue medicines
  • you have no asthma attacks
  • asthma doesn't limit your daily life (including exercise).

Starting treatment

When they’re working out which medicines are best to treat your asthma, your GP or asthma nurse will use an approach recommended in the BTS/SIGN guidelines called ‘stepwise’. 

Treatment for asthma is like a staircase, and you can move up and down a step depending on your current symptoms. The goal is always to make sure your asthma is as well managed as possible using the lowest doses possible. 

So at different times of your life, or even different times of the year, your GP, asthma nurse or hospital consultant can move you up or down a step. The level of treatment that you’re started on will depend on the severity of your symptoms. 

Book annual reviews

Even if your symptoms are well managed, it's important to book in an asthma review at least once a year. This is so you can discuss with your GP or asthma nurse how you’re doing, and they can move you up or down the steps if it’s appropriate.

Book extra reviews if you need them

You don’t have to wait for your next annual review before booking in to see your GP or asthma nurse. For instance, if you haven’t had any asthma symptoms for at least three months, book an extra review. Your GP or asthma nurse may discuss with you a reduction (stepping down) of your medicines dose. Or, if you notice that your asthma symptoms are getting worse (for instance, you're using your reliever inhaler more often than usual; you're coughing, wheezing or feeling breathless; you're waking up at night; your peak flow drops or becomes more variable) book an extra review. Your GP or asthma nurse may increase (step up) your medicines dose. 

Stepping up and stepping down

Before moving you up to a higher level of treatment, your GP or asthma nurse will check to make sure you’ve been taking your medicines as prescribed, using your inhalers correctly and managing your triggers.

Before moving you down to a lower level of treatment, your GP or asthma nurse will consider the severity of your asthma symptoms, the possible side effects of the treatment, how long you’ve been taking the current dose, the benefits of the current dose, the potential risks of reducing the dose and your wishes. You’re most likely to be moved down a step if your asthma has been well managed for at least three months.

If you are moved down a step, you will be asked to keep an eye on your symptoms. If you notice that any symptoms come back (for instance, you’re using your reliever inhaler more often than usual; you’re coughing, wheezing or feeling breathless; you’re waking up at night; your peak flow drops or becomes more variable) make an appointment straight away to see your GP or asthma nurse. You may need to move back up a step. 

The different levels of asthma treatment (for adults and children over 12)

Level one

  • symptoms are usually mild and occur on average less than twice a week
  • treatment is usually a short-acting reliever inhaler for when symptoms occur
  • If you’re using your reliever three times a week or more, or have had an asthma attack in the last two years, you should discuss this with your GP or asthma nurse to see whether your treatment needs to be reviewed. 

Level two

  • treatment is usually a daily preventer inhaler, alongside a short-acting reliever inhaler for when symptoms occur
  • If you’re using reliever inhaler three times a week or more, you’ll need to talk to your GP to see whether your treatment needs changing.  

Level three

  • treatment is usually a daily preventer inhaler
  • you’ll probably be given a long-acting reliever inhaler (this can be prescribed as a separate inhaler or as a combination inhaler in the same device as your daily preventer inhaler)
  • you’ll also be given a short-acting reliever inhaler for when symptoms occur
  • If you’re using reliever inhaler three times a week or more, you’ll need to talk to your GP to see whether your treatment needs changing.  

Level four

  • treatment is usually higher doses of a daily preventer inhaler
  • you’ll probably also be taking a long-acting reliever inhaler (this can be prescribed as a separate inhaler or as a combination inhaler in the same device as your daily preventer inhaler)
  • you’ll be given a short-acting reliever inhaler for when symptoms occur
  • add-on therapies will be prescribed as needed
  • If you’re using reliever inhaler three times a week or more, you’ll need to talk to your GP to see whether your treatment needs changing.  

Level five

  • symptoms are usually more serious and/or more frequent
  • care is usually provided by a consultant who specializes in asthma care
  • treatment is usually higher doses of a daily preventer inhaler
  • you’ll probably also be taking a long-acting reliever inhaler (this can be prescribed as a separate inhaler or as a combination inhaler in the same device as your daily preventer inhaler)
  • you’ll also be given a short-acting reliever inhaler for when symptoms occur
  • add-on therapies and other treatments, including long-term steroid tablets, will be prescribed as needed.

Last updated October 2016

Next review due October 2019