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Clinical Pathway

Asthma Management — Adults & Adolescents

AIR / MART pathway · control assessment · review

Field: RespiratoryCode: RS-01Updated: June 2026Reference: Australian Asthma Handbook / GINA 2025
ICS-containing treatment for all. SABA-only reliever therapy is no longer recommended. Every adult/adolescent with asthma should receive inhaled corticosteroid (ICS) — as regular maintenance, or within ICS-formoterol used as reliever — to cut severe-exacerbation risk.

Stepped treatment — preferred: AIR / MART

ICS-formoterol as the reliever throughout.

1
Low-dose ICS-formoterol as-needed (AIR).
2
Low-dose ICS-formoterol maintenance + as-needed (MART).
3
Medium-dose ICS-formoterol maintenance-and-reliever (MART).
4
Refer: targeted intensive treatment & specialist review.

Alternative — SABA reliever

Maintenance ICS / ICS-LABA + SABA reliever as-needed.

1
Low-dose ICS maintenance + SABA as-needed.
2
Low-dose ICS-LABA maintenance + SABA as-needed.
3
Medium-dose ICS-LABA maintenance + SABA as-needed.
4
Refer: specialist review; consider add-on LAMA.
Exact doses & brands — For device-specific strengths and microgram/day equivalents, use the current National Asthma Council "Asthma treatment levels" chart (nationalasthma.org.au) alongside PBS listing.

Assess symptom control (past 4 weeks)

Good control = all of: daytime symptoms ≤2 days/wk · reliever ≤2 days/wk (excl. pre-exercise) · no night/waking symptoms · no activity limitation. Any of these in the past 4 weeks → poor control.

Step up / step down

  • Before stepping up, confirm: symptoms are due to asthma · inhaler technique correct · adherence adequate.
  • Step up if control not achieved despite good adherence & technique. Specifically on as-needed ICS-formoterol (AIR), reliever ≥3×/wk → add regular maintenance (move to MART).
  • Step down when stable & well-controlled for 2–3 months. Never leave the patient on SABA alone.

Risk factors for exacerbation

Poor symptom control · severe exacerbation in past year (or ever ICU/intubation) · SABA over-use · no/poor ICS or technique · smoking/vaping · obesity · chronic rhinosinusitis · GORD · confirmed food allergy · pregnancy · raised eosinophils/FeNO · low FEV1.

Spirometry

At diagnosis · to investigate poor control or exacerbations · then ~every 2 years even if well-controlled. Monitor pre-bronchodilator FEV1. Do not use clinic PEF to assess control.

Annual review checklist

Symptoms & exacerbations since last visit · triggers, smoking/vaping · recent control · risk factors & lung function · side-effects · inhaler technique · adherence · comorbidities · update written action plan.

Safety

  • Reliever >2 days/wk (poor-control marker) → reassess promptly; don't wait for review.
  • SABA over-reliance & ICS under-use drive exacerbations.
  • Avoid long-term high-dose ICS & repeated oral corticosteroid courses.
  • In pregnancy: do not stop ICS.

Red flags / refer

  • Poor control despite medium-dose ICS-LABA (adherence/technique confirmed) — refer early.
  • Don't wait for high-dose or maintenance OCS.
  • >1 oral corticosteroid course in 12 months, or any ICU admission/intubation for asthma.
  • Diagnostic uncertainty, suspected occupational asthma, or suspected severe eosinophilic/allergic asthma.

RS-01 v1.0 · Reviewed Jun 2026 · Review Jun 2027

For health-professional use. Decision framework adapted from the Australian Asthma Handbook (GINA 2025). Verify device-specific doses at nationalasthma.org.au and PBS criteria at pbs.gov.au.