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Step 4

In step 4, in addition to general non-drug measures, the following drugs are always used:

  • A medication containing cortisone for inhalation in medium to high dosage, e.g. Budesonide metered dose aerosol 0.2 mg 2 x a day 2 sprays. This medication is intended to permanently stabilize your bronchial tubes and to heal allergic or inflammatory processes.
  • A long-acting, inhalable bronchodilator, e.g. Formoterol 12 µg / dose 2 x daily 1-2 puffs, maximum 48 µg / day.
  • As an alternative a combination of a higher dose of the drug containing cortisone (e.g. budesonide metered dose inhaler 0.4 mg twice a day, 2 sprays) with a so-called leukotriene antagonist (e.g. montelukast 10 mg, 1 tablet at night) can be prescribed.

In addition, the following drugs may be used in step 4:

  • Salbutamol, a short acting bronchodilator, 1 puff of 0.1 mg as needed.
  • Tiotropium bromide, provided by powder inhaler (5 µg) 2 x daily can help to dilate the bronchi.
  • If there is a proven connection between the asthmatic symptoms and house dust allergy and hay fever, a so-called sublingual allergen immunotherapy ("SLIT") can be tried. So far, however, there is no good scientific evidence for this treatment. Discuss this option with your doctor!

If you have no more complaints for 3 months, and you rarely need Salbutamol, you can downgrade to step 3 ⇒ step 3

If your symptoms do not improve or only improve slightly, or you frequently need Salbutamol, treatment is carried out according to step 5 ⇒ step 5

Prof. a.D. Dr. Andreas Sönnichsen

Andreas Sönnichsen

Head of the Department of General Medicine and Family Medicine, Center for Public Health, Medical University of Vienna

Prof. a.D. Dr.

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