Physicians guidelines for adjusting therapy
| CS | SS |
| Phase 1 visits and adjustments to therapy each month or at exacerbations | |
| SABA | |
| Administer when needed | Administer when needed |
| ICS | |
| No ICS and controlled | |
| No ICS added | If sp-eos >2% add fluticasone 125 µg b.i.d. of equivalent, then treatment adjusted as for patients on ICS baseline. |
| If sp-eos ≤2% no ICS is added | |
| On ICS and controlled | |
| Reduce ICS two-fold each visit until an exacerbation or fluticasone discontinued (after 125 µg·day−1) | If sp-eos >2% increase ICS dose two–four-fold |
| If sp-eos ≤2% reduce ICS two-fold each visit until sp-eos >2% or fluticasone discontinued (after 125 µg·day−1) | |
| When ICS reduction is followed by an exacerbation | |
| Increase ICS dose two–four-fold to regain control and return dose prior to deterioration, this is the MT | If sp-eos >2% increase ICS dose two–four-fold# for 2 weeks then reduce to 2-fold above the previous dose, this is the MT |
| If on no ICS and uncontrolled | |
| Add fluticasone 125 µg b.i.d. or equivalent. Treatment adjusted as for patients on ICS at baseline | If sp-eos >2% add fluticasone 125 µg b.i.d. or equivalent. Then treatment adjusted as for patients with ICS at baseline. If sp-eos ≤2% increase bronchodilator treatment |
| If on ICS and uncontrolled | |
| Increase ICS two–four-fold or add LABA or other treatments. When controlled treat as above for controlled asthma | If sp-eos >2% increase ICS dose two–four-fold. When controlled treat as above for controlled asthma. If sp-eos ≤2% add LABA or other treatment |
| Exacerbation | |
| Control with two–four-fold increase in dose# until controlled for 2 weeks then reduce to two-fold above exacerbation dose. An antibiotic can be added if purulent sputum | If sp-eos >2% control with two–four-fold increase in dose¶ until controlled for 2 weeks then reduce to two-fold above exacerbation dose |
| If sp-eos ≤2% add or increase LABA dose if the exacerbation is not severe or add antibiotic if cell count suggests bacterial infection | |
| Phase 2 visits and adjustments to therapy every 3 months and exacerbations | |
| Maintain minimum treatment+ | Maintain minimum treatment§ |
| Adjust treatment for exacerbations as in Phase 1 | Adjust treatment for exacerbations as in Phase 1 or for sp-eos >2% as in Phase 1 |
CS: clinical stategy; SS Sputum strategy; SABA: short acting β2-agonist; ICS: inhaled corticosteroid; sp-eos: sputum eosinophils; MT maintenance therapy; LABA: long acting β2-agonist. #: if exacerbation is considered severe by investigator a course of prednisone can be given; ¶: If exacerbation is considered severe by investigator a course of prednisone can be given; +: maintenance could be readjusted if persistent clinical deterioration or if ICS dose was considered to be too high; §: maintenance could be readjusted if there was a persistent eosinophilia or if ICS dose was considered to be too high.