When selecting initial controller treatment in adults and adolescents with the diagnosis of asthma, the Global Initiative for Asthma (GINA), recommends the following.  

Steps 1 to 2: As-needed low-dose ICS formoterol: additional evidence has been added including a systematic review showing significant reduction in emergency visits/ hospitalisations with as-needed ICS-formoterol compared with daily ICS plus as-needed SABA; greater reduction in severe exacerbations in adults and adolescents previously taking SABA alone with as-needed ICS-formoterol compared with daily ICS plus as-needed SABA; similar findings in adolescence as adults, and additional safety data.  

STARTING TREATMENT  

Track one is preferred if the patient is likely to be poorly adherent with daily controller. ICS-containing therapy is recommended even if symptoms are in frequent, as it reduces the risk of severe exacerbations and need for OCS. 

Selecting initial controller treatment in adults and adolescents with asthma 

Abbreviations: ICS: inhaled corticosteroid; SABA: short-acting β2-agonist; LAMA: Long-acting muscarinic antagonists; MART: maintenance and reliever therapy with ICS-formoterol; OCS: oral corticosteroids; SABA: short-acting beta2-agonist. 

REFERENCES: Global initiative for asthma. Global strategy for asthma management and prevention, 2022.  Available from: www.Ginasthma.org