Introduction

Despite the advent of new asthma therapies, inhaled corticosteroids (ICS) remain the most effective agents for gaining and maintaining control of asthma. The underlying inflammatory nature of asthma means that inhaled corticosteroids are the mainstay of management for patients with persistent disease at any level of severity. The use of inhaled corticosteroids has been associated with lower asthma mortality rates and a reduced need for hospitalisation,¹ as well as an improvement in quality of life for children and adults with asthma.

The key goal of asthma management with inhaled corticosteroids is to achieve optimal asthma control with the lowest effective dose. The dose of ICS needed to gain control of asthma should be that which is most appropriate to the severity of the underlying disease. Importantly, the dose should then be reduced as necessary to maintain symptom control.² There is now level 1 evidence to show that most of the clinical benefit of inhaled corticosteroids is derived with low to moderate doses, with little or no further benefit at higher doses.^{3, 4} Regular review is important to enable proper assessment and maintenance of asthma control.

What is meant by low, medium and high dose ICS in adult asthma?2
	Total daily dose
Low	Up to 250 mcg BDP-HFA or FP; up to 400 mcg BUD
Medium	Up to 500 mcg BDP-HFA or FP; up to 800 mcg BUD
High	500 mcg or above BDP-HFA or FP; 800 mcg or above BUD
BDP-HFA = beclomethasone dipropionate; FP = fluticasone propionate; BUD = budesonide

 Classification of underlying asthma severity will determine the appropriate level of therapy required to gain control of asthma. Refer to the National Asthma Council's Asthma Management Handbook ² for further information regarding the classification of asthma severity.