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Step 5

Treatment in step 5 should usually be agreed with a specialist in bronchial asthma. Your doctor should refer you to this if necessary.

In step 5, 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 times a day 2-3 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, maximum 48 µg / day.
  • As an alternative to the combination of a drug containing cortisone and a long-acting bronchodilator drug, a combination of a higher dose of the drug containing cortisone (e.g. budesonide metered dose inhaler 0.2 mg twice a day, 3-4 sprays) with a so-called leukotriene antagonist (e.g. montelukast 10 mg, 1 tablet at night).

In addition, the following drugs are used in step 5:

  • Salbutamol-spray (0.1 mg/puff) as needed, maximum 10 puffs per day
  • Tiotropium bromide, powder inhaler (5 mg) 2 x daily
  • 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!
  • Cortisone tablets: Start with prednisolone 7.5 mg daily for 14 days, then gradually reduce the dose to the lowest possible dose at which you are still (somewhat) free of symptoms.
  • If your asthma is allergic and you have a high IgE level in your blood (blood test required!), Treatment with omalizumab may be tried. This therapy is only carried out by a specialist! However, scientific evidence for the effectiveness of this therapy has so far been insufficient.
  • If you have so-called "eosinophilia" in your blood and therefore suffer from "eosinophilic asthma", treatment with mepolizumab can be tried. This treatment is also only carried out by a specialist. The scientific evidence for the effectiveness of this therapy is so far insufficient!
  • If your asthma is caused by a so-called type 2 inflammation (this can be tested by a specialist, the new drug Dupilumab can be prescribed. Research for the effectiveness is limited, though.
  • If the asthma cannot be brought under control with all the measures mentioned, a so-called "bronchial thermo plasticity" can be performed. This measure is only carried out in special clinics and usually as part of scientific examinations. The knowledge about the benefits and risks of this measure is still very limited.

If you no longer have any symptoms for 3 months under step 5 therapy, you can downgrade to step 4 ⇒ step 4

If your symptoms do not or only slightly improve under level 5 therapy, you should be referred to a specialist clinic for asthma.

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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