Maintenance therapies
| Maintenance therapies | Comments |
| ICS | Currently used as a first-line maintenance agent in a number of national guidelines20 31 49 50; when using ICS, the lowest possible dose to effectively control symptoms should be used to prevent possible adverse effects of reduced growth and risk of adrenal suppression. |
| LABA | Used as an add-on therapy when dual ICS and SABA therapy is ineffective. In comparison to SABA, bronchodilation duration is prolonged to 12 hours. |
| Leucotriene receptor antagonists (eg, montelukast) | Used as an add-on therapy in those who have poor symptom control despite ICS and LABA treatments20 24 27 30 32 49 There have been a number of concerns raised regarding possible adverse reactions to montelukast. These include neuropsychiatric features ranging from poor sleep to suicidal ideation.66 |
| Long-acting muscarinic antagonists (eg, tiotropium) | Used as an add-on therapy in those who have poor symptoms control despite ICS and LABA therapies |
| Oral theophylline | Used as an add-on therapy, usually in those with uncontrolled symptoms despite several maintenance and reliever therapies Monitoring of plasma level required on initiation of treatment and dose changes |
| Biologics | Use as an add-on therapy, under specialist care, in those who have poorly controlled symptoms despite being on several maintenance and reliever therapies. A number of biologic agents are available (table 6). Various individual biologics have been shown to reduce attacks, improve lung function and reduce oral corticosteroid use.18 |
ICS, inhaled corticosteroid; LABA, long-acting beta-2 agonists; SABA, short-acting beta-2 agonist.