The application of budesonide/formoterol (Symbicort) adjustable maintenance dosing to real-life clinical practice

Despite effective drugs and devices, optimal asthma control is rarely achieved long term. Clinicians should consider both the therapies and management strategies employed, Adjustable maintenance dosing, where patients step-up or step-down their medication depending on symptom level, has been proposed to improve asthma control in a real-life setting. To implement adjustable maintenance dosing, patients require a Personalised Asthma Action Plan, detailing instructions agreed between patient and clinician on how they should adjust their dose in line with asthma variations to prevent deterioration in control. Several factors are necessary to achieve a clinician-agreed and supported patient-adjusted management strategy: effective therapy; patient willingness to participate in their action plan, which should not lie over-complicated to follow; adequate physician time for patient education about their disease and action plan. Results from eight studies have shown that adjustable maintenance dosing is practical and results in equal or better control with less medication use and lower costs than fixed dosing.